Missouri's Juvenile Justice System - ABC News
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About Us
- Kathlene B. LaCour and Craig S. Judd
- Passages Behavioral Health Services was founded out of need to service mentally ill, co-occurring, correctional clients seeking a second chance. Our 40 years of clinical experience has prepared us to do this work which includes providing case management, Community Living Suppports (CLS), clinical assessment, treatment planning and more. Passages Behavioral Health also manages re-entry housing for this population know as the Passages House. We provide a service that not only bridges folks to another chance but helps maintain their progress in the community.
Wednesday, September 09, 2009
Tuesday, August 25, 2009
Words to Live By.....
" Watch your thoughts; they become words. Watch your words; they become actions. Watch your actions; they become habits. Watch your habits; they become character. Watch your character; it becomes your destiny."
- Frank Outlaw
- Frank Outlaw
Friday, July 10, 2009
Battered Woman Syndrome; Trauma and Violence
July 7, 2009
Psychiatric Times. Vol. 26 No. 7
TRAUMA AND VIOLENCE
Battered Woman Syndrome
Key Elements of a Diagnosis and Treatment Plan
Lenore E. Walker, EdD, ABPP-CL & Fam
Women who are victims of intimate-partner violence have been identified by the mental health field for more than 30 years now.1-3 It is understood that domestic violence is part of gender violence, and that many more women than men are the victims of physical, sexual, and psychological abuse.4-6 Even when women strike back or engage in mutual violence, it is usually the woman who is most likely to be hurt—both physically and emotionally. Women who strike back in self-defense are often arrested along with the batterer.
It is further understood that gender violence is fostered by the socialization of men to be more powerful than women. In some men, this process creates the need to abuse power and to control women.5 While the term “victim” is not always considered politically correct, in fact, until battered women take back some control over their lives, they may not truly be considered survivors.7 Psychological symptoms, called battered woman syndrome (BWS), develop in some women and make it difficult for them to regain control. Mental health professionals have been able to assist these battered women with empowerment techniques and with accurate diagnosis and proper treatment, as described here.
BATTERED WOMAN SYNDROME
BWS has been identified as a subcategory of posttraumatic stress disorder (PTSD).8 Although not all battered women meet all the DSM-IV-TR criteria for PTSD,9 a sufficient number do; thus, a form of trauma treatment is most helpful.10
Table 1 lists 6 groups of criteria that recently have been found to be part of BWS.8
DIAGNOSIS
A number of steps will help you obtain accurate information when you are interviewing a woman whom you believe may be abused by her intimate partner (Table 2).
Safety
Begin by speaking with the woman without her partner present (if they are still together) and together form a safety plan. This can be difficult because batterers often want to be present during the entire examination so they can directly or even subtly remind the woman not to disclose their secret. It is not uncommon to feel as if the man were in the interview—even if he is waiting outside.
For a woman in a battering relationship, the most dangerous time is when she and her partner are discussing or thinking about separation.11,12 Even if the woman is no longer living with the batterer, she may not be safe. It is important to help her feel safer by making it clear that you will not take advantage of her. The clinician can set up boundaries between himself or herself and the woman by asking her permission to touch her, to write notes, and to discuss areas of confidentiality and privilege. Individual or group therapy rather than couples therapy is recommended, at least initially.
Validation
A battered woman needs to feel validated when she describes the abuse. This can be done by emphasizing the positive things she did to protect herself and her children if they were involved. Tell her that no matter what she may have done or said, no one deserves to be abused. Be careful not to ask or even intimate that she might have done something to provoke the batterer. Such questions will not create the rapport that facilitates empowerment—nor do they create a safe space for the woman.
Most battered women have been told of their faults over and over by the batterer. They also have experienced his jealousy, overpossessiveness, and attempts to isolate them from significant friends or family. They may need education about the impact of abuse on their physical as well as mental health.13
Therapy should emphasize the woman’s strengths so that she trusts herself and others again. Naming her a battered woman with BWS may help her accept that she is not “crazy” (as the batterer predicted her doctor would find).
Risk and assessment and more....
If you need help please contact your local domestic violence center, mental health center or national hotline 1-800-799-SAFE (7233) .
Psychiatric Times. Vol. 26 No. 7
TRAUMA AND VIOLENCE
Battered Woman Syndrome
Key Elements of a Diagnosis and Treatment Plan
Lenore E. Walker, EdD, ABPP-CL & Fam
Women who are victims of intimate-partner violence have been identified by the mental health field for more than 30 years now.1-3 It is understood that domestic violence is part of gender violence, and that many more women than men are the victims of physical, sexual, and psychological abuse.4-6 Even when women strike back or engage in mutual violence, it is usually the woman who is most likely to be hurt—both physically and emotionally. Women who strike back in self-defense are often arrested along with the batterer.
It is further understood that gender violence is fostered by the socialization of men to be more powerful than women. In some men, this process creates the need to abuse power and to control women.5 While the term “victim” is not always considered politically correct, in fact, until battered women take back some control over their lives, they may not truly be considered survivors.7 Psychological symptoms, called battered woman syndrome (BWS), develop in some women and make it difficult for them to regain control. Mental health professionals have been able to assist these battered women with empowerment techniques and with accurate diagnosis and proper treatment, as described here.
BATTERED WOMAN SYNDROME
BWS has been identified as a subcategory of posttraumatic stress disorder (PTSD).8 Although not all battered women meet all the DSM-IV-TR criteria for PTSD,9 a sufficient number do; thus, a form of trauma treatment is most helpful.10
Table 1 lists 6 groups of criteria that recently have been found to be part of BWS.8
DIAGNOSIS
A number of steps will help you obtain accurate information when you are interviewing a woman whom you believe may be abused by her intimate partner (Table 2).
Safety
Begin by speaking with the woman without her partner present (if they are still together) and together form a safety plan. This can be difficult because batterers often want to be present during the entire examination so they can directly or even subtly remind the woman not to disclose their secret. It is not uncommon to feel as if the man were in the interview—even if he is waiting outside.
For a woman in a battering relationship, the most dangerous time is when she and her partner are discussing or thinking about separation.11,12 Even if the woman is no longer living with the batterer, she may not be safe. It is important to help her feel safer by making it clear that you will not take advantage of her. The clinician can set up boundaries between himself or herself and the woman by asking her permission to touch her, to write notes, and to discuss areas of confidentiality and privilege. Individual or group therapy rather than couples therapy is recommended, at least initially.
Validation
A battered woman needs to feel validated when she describes the abuse. This can be done by emphasizing the positive things she did to protect herself and her children if they were involved. Tell her that no matter what she may have done or said, no one deserves to be abused. Be careful not to ask or even intimate that she might have done something to provoke the batterer. Such questions will not create the rapport that facilitates empowerment—nor do they create a safe space for the woman.
Most battered women have been told of their faults over and over by the batterer. They also have experienced his jealousy, overpossessiveness, and attempts to isolate them from significant friends or family. They may need education about the impact of abuse on their physical as well as mental health.13
Therapy should emphasize the woman’s strengths so that she trusts herself and others again. Naming her a battered woman with BWS may help her accept that she is not “crazy” (as the batterer predicted her doctor would find).
Risk and assessment and more....
If you need help please contact your local domestic violence center, mental health center or national hotline 1-800-799-SAFE (7233) .
Friday, May 15, 2009
Caffeine: Upper or Placebo
posted Monday, 4 May 2009
Jennifer Nachbur
Jennifer Nachbur
Ever miss your daily cup of coffee and subsequently get a pounding headache? According to reports from consumers of coffee and other caffeinated products, caffeine withdrawal is often characterized by a headache, fatigue, feeling less alert, less energetic and experiencing difficulty concentrating.
Researchers from the University of Vermont College of Medicine and Johns Hopkins School of Medicine sought to investigate the biological mechanisms of caffeine withdrawal in a paper published recently in the online edition of the scientific journal Psychopharmacology. They looked at brain electrical activity and blood flow during caffeine withdrawal to examine what was taking place physiologically during acute caffeine abstinence, including the likely mechanism underlying the common "caffeine withdrawal headache."
The group examined caffeine's effects in a double-blind study, which involved the administration of caffeine and placebo capsules. Each participant's response to the caffeine or placebo was measured using three different measures - brain electrical activity via electroencephalogram (EEG); blood flow velocity in the brain via ultrasound; and participants' self-reports of subjective effects via questionnaires.
The team demonstrated that stopping daily caffeine consumption produces changes in cerebral blood flow velocity and quantitative EEG that are likely related to the classic caffeine withdrawal symptoms of headache, drowsiness and decreased alertness. More specifically, acute caffeine abstinence increased brain blood flow, an effect that may account for commonly reported withdrawal headaches. Acute caffeine abstinence also produced changes in EEG (increased theta rhythm) that has previously been linked to the common withdrawal symptom of fatigue.
Consistent with this, volunteers reported increases in measures of "tired," "fatigue," "sluggish" and "weary." Overall, these findings provide the most rigorous demonstration to date of physiological effects of caffeine withdrawal.
The researchers also discovered a provocative and somewhat unexpected finding - that there were no net benefits associated with regular caffeine consumption.
"In addition to looking at caffeine withdrawal, this rigorous design also permitted comparison of chronic caffeine maintenance with chronic placebo maintenance, which provides unique information about the extent to which there are net beneficial effects of daily caffeine administration," said Stacey Sigmon, PhD, research associate professor of psychiatry at the University of Vermont and first author on the study. "In contrast to what most of us coffee lovers would think, our study showed no difference between when the participant was maintained on chronic placebo and when the participant was stabilized on chronic caffeine administration. What this means is that consuming caffeine regularly does not appear to produce any net beneficial effects, based on the measures we examined."
Sigmon SC, Herning RI, Better W, et al. Caffeine withdrawal, acute effects, tolerance, and absence of net beneficial effects of chronic administration: cerebral blood flow velocity, quantitative EEG, and subjective effects. Psychopharmacology (Berl). 2009;doi:10.1007/s00213-009-1489-4 [Abstract]
Friday, April 24, 2009
Refusing to Forgive by E. Goldstein
Refusing to Forgive: 9 Steps to Break FreeBy Elisha Goldstein, Ph.D. April 15, 2009
I see it every day. We all hold grudges against other people who we feel have hurt or offended us in some way or another. We even hold these grudges for people who aren’t even alive anymore. We do this with the false idea that somehow we are making them suffer by being hurt and angry with them. Now, there is nothing wrong with being angry with someone, but it is how we express this anger that makes all the difference on us and our relationships . What is a grudge anyway? May it is harboring ill feelings toward another in the need to settle a score.
Let’s try a little experiment. Think of someone in your life right now (maybe not the most extreme person) who you are absolutely holding a grudge against right now. There is no way you are willing to forgive this person right now for their actions. Picture that person and hold onto that unwillingness to forgive. Now, just observe what emotions are there; Anger, resentment, sadness? Also notice how you are holding your body right now, is it tense anywhere or feeling heavy? Now bring awareness to your thoughts; are they hateful and spiteful thoughts?
Most people who I do this with find this to be an uncomfortable experiment that elicits feelings of tension, anger, and thoughts of ill will toward the other person. This is not conjuring these feelings out of nowhere; this is just bringing to light what is already within stirring around. There is a common misperception that forgiveness means condoning the act of the other person. Forgiveness simply means releasing this cycle of torture that continues to reside inside.
Forgiving does not mean forgetting or condoning! Forgiveness is for the person who was perpetrated, not the perpetrator. It is saying, “I have already been offended against, I am going to let go of this so I don’t continue to be burdened by it.” You have already been tortured once, why continue letting this torture you by holding onto it with the erroneous belief that holding onto it is somehow hurting the other person. The practice of forgiveness has been shown to reduce stress, anger, and depression and support many aspects of well-being and happiness.
Like many things, this is easier said than done depending on the person and level of offense. In his book, Forgive for Good, Fred Luskin, Ph.D. lays out 9 steps to forgiving for you!
I see it every day. We all hold grudges against other people who we feel have hurt or offended us in some way or another. We even hold these grudges for people who aren’t even alive anymore. We do this with the false idea that somehow we are making them suffer by being hurt and angry with them. Now, there is nothing wrong with being angry with someone, but it is how we express this anger that makes all the difference on us and our relationships . What is a grudge anyway? May it is harboring ill feelings toward another in the need to settle a score.
Let’s try a little experiment. Think of someone in your life right now (maybe not the most extreme person) who you are absolutely holding a grudge against right now. There is no way you are willing to forgive this person right now for their actions. Picture that person and hold onto that unwillingness to forgive. Now, just observe what emotions are there; Anger, resentment, sadness? Also notice how you are holding your body right now, is it tense anywhere or feeling heavy? Now bring awareness to your thoughts; are they hateful and spiteful thoughts?
Most people who I do this with find this to be an uncomfortable experiment that elicits feelings of tension, anger, and thoughts of ill will toward the other person. This is not conjuring these feelings out of nowhere; this is just bringing to light what is already within stirring around. There is a common misperception that forgiveness means condoning the act of the other person. Forgiveness simply means releasing this cycle of torture that continues to reside inside.
Forgiving does not mean forgetting or condoning! Forgiveness is for the person who was perpetrated, not the perpetrator. It is saying, “I have already been offended against, I am going to let go of this so I don’t continue to be burdened by it.” You have already been tortured once, why continue letting this torture you by holding onto it with the erroneous belief that holding onto it is somehow hurting the other person. The practice of forgiveness has been shown to reduce stress, anger, and depression and support many aspects of well-being and happiness.
Like many things, this is easier said than done depending on the person and level of offense. In his book, Forgive for Good, Fred Luskin, Ph.D. lays out 9 steps to forgiving for you!
- Know exactly how you feel about what happened and be able to articulate what about the situation is not OK. Then, tell a trusted couple of people about your experience.
- Make a commitment to yourself to do what you have to do to feel better. Forgiveness is for you and not for anyone else.
- Forgiveness does not necessarily mean reconciliation with the person that hurt you, or condoning of their action. What you are after is to find peace. Forgiveness can be defined as the “peace and understanding that come from blaming that which has hurt you less, taking the life experience less personally, and changing your grievance story.”
- Get the right perspective on what is happening. Recognize that your primary distress is coming from the hurt feelings, thoughts and physical upset you are suffering now, not what offended you or hurt you two minutes - or ten years -ago. Forgiveness helps to heal those hurt feelings.
- At the moment you feel upset practice a simple stress management technique to soothe your body’s flight or fight response.
- Give up expecting things from other people, or your life, that they do not choose to give you. Recognize the “unenforceable rules” you have for your health or how you or other people must behave. Remind yourself that you can hope for health, love, peace and prosperity and work hard to get them.
- Put your energy into looking for another way to get your positive goals met than through the experience that has hurt you. Instead of mentally replaying your hurt seek out new ways to get what you want.
- Remember that a life well lived is your best revenge. Instead of focusing on your wounded feelings, and thereby giving the person who caused you pain power over you, learn to look for the love, beauty and kindness around you. Forgiveness is about personal power.
- Amend your grievance story to remind you of the heroic choice to forgive.
Wednesday, April 08, 2009
Why You're Not Sleeping
Provided by: FORBESWritten by: Rebecca Ruiz, Forbes.com Mar. 10, 2009
The recession has forced Americans to cut back on everything from health care to groceries. According to the results of a poll released Monday, it's also driving them to give up a precious commodity that doesn't cost a cent: sleep.
More than a quarter of 1,000 Americans randomly polled by the National Sleep Foundation, a non-profit organization that promotes a greater understanding of sleep and health, reported that the economy had disturbed their sleep at least a few nights a week.
Personal finances, unemployment and health care costs are among the troubles keeping people awake. The percentage of Americans experiencing economy-related insomnia may have worsened since the telephone poll was conducted over a month-long period beginning in late September.
In Depth: Nine Ways To Conquer Insomnia
The fact that Americans are sleeping less is unsurprising; the National Sleep Foundation has been documenting the dwindling hours of shut-eye for the past decade. The increasing number of sleep aid prescriptions is also telling. In 2008, 56.3 million prescriptions were filled, a 7% growth from 2007, according to IMS Health, a health care information company.
"Sleep is a barometer of life," says Dr. Meir Kryger, chairman of the board for the National Sleep Foundation. People suffering from severe sleep problems, he says, often fail to recognize the very simple reasons they can't drift off peacefully. Anxiety born of economic woes is a major factor, but so are sleep disorders and bad habits like an unpredictable schedule, performing late-night tasks and even staying in bed when it's impossible to fall asleep.
What it Means Not to Sleep
At least 40 million Americans experience chronic sleep disorders, according to the National Institutes of Health, which recommends that adults get seven to eight hours of sleep each night. The National Sleep Foundation's poll shows that Americans routinely fall short of this goal, sleeping an average of six hours and 40 minutes per week night.
Sleep debt has a profound impact on a person's ability to function, says Dr. Carol Ash, medical director for Sleep for Life, a New Jersey-based sleep laboratory. Research has shown that it impairs judgment, focus, memory and reaction times. Eighteen hours of consecutive wakefulness is the equivalent of a blood alcohol level of .08%. The effects of sleep deprivation are cumulative, meaning that several nights of disturbed sleep can compound the ill effects of missed sleep.
There are the classic signs of sleep loss, including irritability, anxiety and depression, but less obvious, says Ash, are diminished problem-solving skills. The sleep-deprived may try pushing through fatigue to get their jobs done or developing last-minute solutions to urgent crises (think Congress). That's often the worst approach for the sleep-deprived to take.
"You'll be able to do mundane tasks," Ash says, "but you'll really start to fail when you have to think outside of the box."
Simple Sleep Solutions
With the exception of disorders that like apnea or narcolepsy, most sleep issues are caused by stress and bad habits. Spending a few nights awake, besieged by worries or because you're trying to return e-mails just before bed, for example, can teach the body a routine that is not conducive to sleep.
Dr. Eric Powell, director of research at the Clayton Sleep Institute in Missouri, often tells insomniacs to get out of bed. It sounds counterintuitive, but the strategy is based on research that has shown efforts to force the body to sleep only breed frustration.
When that cycle of sleep-related stress begins, he says, it can be hard for patients to identify obvious reasons for their insomnia. These frequently include an unpredictable schedule, a noisy or brightly lit sleeping environment or the lack of a nightly ritual. In other cases, sleep disturbances are related to a chronic disease. Diabetics, for example, experience increased discomfort as a result of damage to the nerves in the feet and legs.
Experts say that the sleep-deprived should seek professional help when the problem becomes chronic and self-imposed remedies fail. At that point, treatment may require prescription medicine or therapy.
When counseling patients affected by the economy, Kryger reminds them that the recession will pass. Tuning out anxiety not only aids with the coping process, it's also necessary for moving on.
Showing up at an interview looking ragged won't impress, he says. If nothing else, "you need your sleep to get another job."
The recession has forced Americans to cut back on everything from health care to groceries. According to the results of a poll released Monday, it's also driving them to give up a precious commodity that doesn't cost a cent: sleep.
More than a quarter of 1,000 Americans randomly polled by the National Sleep Foundation, a non-profit organization that promotes a greater understanding of sleep and health, reported that the economy had disturbed their sleep at least a few nights a week.
Personal finances, unemployment and health care costs are among the troubles keeping people awake. The percentage of Americans experiencing economy-related insomnia may have worsened since the telephone poll was conducted over a month-long period beginning in late September.
In Depth: Nine Ways To Conquer Insomnia
The fact that Americans are sleeping less is unsurprising; the National Sleep Foundation has been documenting the dwindling hours of shut-eye for the past decade. The increasing number of sleep aid prescriptions is also telling. In 2008, 56.3 million prescriptions were filled, a 7% growth from 2007, according to IMS Health, a health care information company.
"Sleep is a barometer of life," says Dr. Meir Kryger, chairman of the board for the National Sleep Foundation. People suffering from severe sleep problems, he says, often fail to recognize the very simple reasons they can't drift off peacefully. Anxiety born of economic woes is a major factor, but so are sleep disorders and bad habits like an unpredictable schedule, performing late-night tasks and even staying in bed when it's impossible to fall asleep.
What it Means Not to Sleep
At least 40 million Americans experience chronic sleep disorders, according to the National Institutes of Health, which recommends that adults get seven to eight hours of sleep each night. The National Sleep Foundation's poll shows that Americans routinely fall short of this goal, sleeping an average of six hours and 40 minutes per week night.
Sleep debt has a profound impact on a person's ability to function, says Dr. Carol Ash, medical director for Sleep for Life, a New Jersey-based sleep laboratory. Research has shown that it impairs judgment, focus, memory and reaction times. Eighteen hours of consecutive wakefulness is the equivalent of a blood alcohol level of .08%. The effects of sleep deprivation are cumulative, meaning that several nights of disturbed sleep can compound the ill effects of missed sleep.
There are the classic signs of sleep loss, including irritability, anxiety and depression, but less obvious, says Ash, are diminished problem-solving skills. The sleep-deprived may try pushing through fatigue to get their jobs done or developing last-minute solutions to urgent crises (think Congress). That's often the worst approach for the sleep-deprived to take.
"You'll be able to do mundane tasks," Ash says, "but you'll really start to fail when you have to think outside of the box."
Simple Sleep Solutions
With the exception of disorders that like apnea or narcolepsy, most sleep issues are caused by stress and bad habits. Spending a few nights awake, besieged by worries or because you're trying to return e-mails just before bed, for example, can teach the body a routine that is not conducive to sleep.
Dr. Eric Powell, director of research at the Clayton Sleep Institute in Missouri, often tells insomniacs to get out of bed. It sounds counterintuitive, but the strategy is based on research that has shown efforts to force the body to sleep only breed frustration.
When that cycle of sleep-related stress begins, he says, it can be hard for patients to identify obvious reasons for their insomnia. These frequently include an unpredictable schedule, a noisy or brightly lit sleeping environment or the lack of a nightly ritual. In other cases, sleep disturbances are related to a chronic disease. Diabetics, for example, experience increased discomfort as a result of damage to the nerves in the feet and legs.
Experts say that the sleep-deprived should seek professional help when the problem becomes chronic and self-imposed remedies fail. At that point, treatment may require prescription medicine or therapy.
When counseling patients affected by the economy, Kryger reminds them that the recession will pass. Tuning out anxiety not only aids with the coping process, it's also necessary for moving on.
Showing up at an interview looking ragged won't impress, he says. If nothing else, "you need your sleep to get another job."
Thursday, March 19, 2009
Getting Help: Locate Services
If unsure where to go for help, talk to someone you trust who has experience in mental health—for example, a doctor, nurse, social worker, or religious counselor. Ask their advice on where to seek treatment. If there is a university nearby, its departments of psychiatry or psychology may offer private and/or sliding-scale fee clinic treatment options. Otherwise, check the Yellow Pages under "mental health," "health," "social services," "crisis intervention services," "hotlines," "hospitals," or "physicians" for phone numbers and addresses. In times of crisis, the emergency room doctor at a hospital may be able to provide temporary help for a mental health problem, and will be able to tell you where and how to get further help.
Listed below are the types of people and places that will make a referral to, or provide, diagnostic and treatment services.
Family doctors
Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors
Religious leaders/counselors
Health maintenance organizations
Community mental health centers
Hospital psychiatry departments and outpatient clinics
University- or medical school-affiliated programs
State hospital outpatient clinics
Social service agencies
Private clinics and facilities
Employee assistance programs
Local medical and/or psychiatric societies
Locate Mental Health Services in Your Area Within the Federal government, the Substance Abuse and Mental Health Services Administration (SAMHSA) offers a Services Locator for mental health and substance abuse treatment programs and resources nationwide.
Centers for Medicare and Medicaid Services (CMS) CMS is the the federal agency responsible for administering the Medicare, Medicaid, State Children's Health Insurance (SCHIP) and several other programs that help people pay for health care.
Locate Affordable Healthcare in Your Area Within the Federal Government, a bureau of the Health Resources and Services Administration (HRSA) provides a Health Center Database for a nationwide directory of clinics to obtain low or no-cost healthcare.
Locate NIMH Clinical Trials currently seeking participants.
Mental Health Information and Organizations from NLM's MedlinePlus (en Español)
If You Are in a Crisis and Need Immediate Help
Listed below are the types of people and places that will make a referral to, or provide, diagnostic and treatment services.
Family doctors
Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors
Religious leaders/counselors
Health maintenance organizations
Community mental health centers
Hospital psychiatry departments and outpatient clinics
University- or medical school-affiliated programs
State hospital outpatient clinics
Social service agencies
Private clinics and facilities
Employee assistance programs
Local medical and/or psychiatric societies
Locate Mental Health Services in Your Area Within the Federal government, the Substance Abuse and Mental Health Services Administration (SAMHSA) offers a Services Locator for mental health and substance abuse treatment programs and resources nationwide.
Centers for Medicare and Medicaid Services (CMS) CMS is the the federal agency responsible for administering the Medicare, Medicaid, State Children's Health Insurance (SCHIP) and several other programs that help people pay for health care.
Locate Affordable Healthcare in Your Area Within the Federal Government, a bureau of the Health Resources and Services Administration (HRSA) provides a Health Center Database for a nationwide directory of clinics to obtain low or no-cost healthcare.
Locate NIMH Clinical Trials currently seeking participants.
Mental Health Information and Organizations from NLM's MedlinePlus (en Español)
If You Are in a Crisis and Need Immediate Help
Wednesday, March 11, 2009
Salt Cravings and Depression
See research regarding the relationship between salt intake and mood.
Of particular importance are experience-dependent processes including the sensitization of the neural systems underlying sodium appetite and the effects of sodium balance on hedonic state and mood. Accumulating evidence suggests that plasticity within the central nervous system as a result of experience with high salt intake, sodium depletion, or a chronic unresolved sodium appetite fosters enduring changes in sodium related appetitive and consummatory behaviors.
see Science Direct for more....
Of particular importance are experience-dependent processes including the sensitization of the neural systems underlying sodium appetite and the effects of sodium balance on hedonic state and mood. Accumulating evidence suggests that plasticity within the central nervous system as a result of experience with high salt intake, sodium depletion, or a chronic unresolved sodium appetite fosters enduring changes in sodium related appetitive and consummatory behaviors.
see Science Direct for more....
Thursday, February 05, 2009
Mindfulness
Mindfulness is intentionally paying attention to the present moment while putting aside our preconceived ideas, expectations, and judgments. It is being in connection with the here and now.Over the past 30 years there has been a buildup of evidence-based research using mindfulness practice to work with difficult medical and mental health issues such as stress, anxiety, depression, relationships, addiction, insomnia, chronic pain, immune function, cancer, trauma, and more.
Check this out: Mindfulness Blog by Dr. Goldstein:
"The practice of mindfulness teaches us a different way to relate to our thoughts, feelings, and emotions as they arise. It is about learning to approach and acknowledge whatever is happening in the present moment, setting aside our lenses of judgment and just being with whatever is there, rather than avoiding it or needing to fix it. It’s the mind’s attempt to avoid and fix things in this moment that fuels the negative mood. So, if sadness is there, instead of trying to fix it or figure it out, we might just acknowledge the sadness and let it be. If self-judgments arise (e.g., I am weak, I am a loser) out of past sensitivities to having been depressed before, we can acknowledge that they are associations from teh past, let them be, and then gently bring ourselves back to whatever we were doing. In doing this, we’re stopping the ruminative cycle that might occur between our thoughts, feelings, and physical sensations that can play off one another leading us to a relapse.
Now, this is easier said than done and it takes practice.
Practice - One way to practice mindfulness is to use the breath as an object of awareness. You can place attention at the tip of the nose or the belly and as you breathe in, just acknowledge the breath coming in and as you breathing out just acknowledge the breathe going out. As if you were greeting and saying goodbye to an old friend. When the mind wanders, as it will always do, just say to yourself “wandering” and then gently bring your attention back to the breath just noticing it coming in and going out. Most of us catch the mind wandering and gently bring it back billions of times, so know that it is normal for the mind to wander often. You can do this for as little as 1 minute or as much as 30 minutes or more."
Check this out: Mindfulness Blog by Dr. Goldstein:
"The practice of mindfulness teaches us a different way to relate to our thoughts, feelings, and emotions as they arise. It is about learning to approach and acknowledge whatever is happening in the present moment, setting aside our lenses of judgment and just being with whatever is there, rather than avoiding it or needing to fix it. It’s the mind’s attempt to avoid and fix things in this moment that fuels the negative mood. So, if sadness is there, instead of trying to fix it or figure it out, we might just acknowledge the sadness and let it be. If self-judgments arise (e.g., I am weak, I am a loser) out of past sensitivities to having been depressed before, we can acknowledge that they are associations from teh past, let them be, and then gently bring ourselves back to whatever we were doing. In doing this, we’re stopping the ruminative cycle that might occur between our thoughts, feelings, and physical sensations that can play off one another leading us to a relapse.
Now, this is easier said than done and it takes practice.
Practice - One way to practice mindfulness is to use the breath as an object of awareness. You can place attention at the tip of the nose or the belly and as you breathe in, just acknowledge the breath coming in and as you breathing out just acknowledge the breathe going out. As if you were greeting and saying goodbye to an old friend. When the mind wanders, as it will always do, just say to yourself “wandering” and then gently bring your attention back to the breath just noticing it coming in and going out. Most of us catch the mind wandering and gently bring it back billions of times, so know that it is normal for the mind to wander often. You can do this for as little as 1 minute or as much as 30 minutes or more."
Sunday, November 30, 2008
It takes guts and low serotonin levels to build bone
By Elizabeth Streich
Bone growth is controlled in the gut through serotonin, the same naturally present chemical used by the brain to influence mood, appetite and sleep, according to a new discovery from researchers at Columbia University Medical Center. Until now, the skeleton was thought to control bone growth, and serotonin was primarily known as a neurotransmitter acting in the brain. This new insight could transform how osteoporosis is treated in the future by giving doctors a way to increase bone mass, not just slow its loss. Findings are reported in the Nov. 26, 2008 issue of Cell.
See Anxiety Insights for more.....
Bone growth is controlled in the gut through serotonin, the same naturally present chemical used by the brain to influence mood, appetite and sleep, according to a new discovery from researchers at Columbia University Medical Center. Until now, the skeleton was thought to control bone growth, and serotonin was primarily known as a neurotransmitter acting in the brain. This new insight could transform how osteoporosis is treated in the future by giving doctors a way to increase bone mass, not just slow its loss. Findings are reported in the Nov. 26, 2008 issue of Cell.
See Anxiety Insights for more.....
Saturday, November 29, 2008
The Complex Relationship Between Menstrual Cyclicity and Anxiety Disorders
Miki Peer, Claudio N. Soares, MD, PhD, and Meir Steiner, MD, PhD
Ms Peer reports that she has no conflicts of interest concerning the subject matter of this article. Dr Soares reports that he has received grant/research support from AstraZeneca and GlaxoSmithKline; he is a consultant for Sepracor, GlaxoSmithKline, Wyeth-Ayerst, and Neurocrine; and he is on the Promotional Speakers' Bureau of GlaxoSmithKline, Wyeth-Ayerst, Forest Laboratories, and Pfizer. Dr Steiner reports that he has received grant/ research support from Wyeth, Pfizer, and AstraZeneca; he is a consultant for Eli Lilly, Pfizer, GlaxoSmithKline, Lundbeck, Novartis, Wyeth, OrthoMcNeil, AstraZeneca, and Azevan Pharmaceuticals; he is on the advisory board of Eli Lilly, GlaxoSmithKline, Pfizer, Lundbeck, OrthoMcNeil, Wyeth, Schering, Ferring, and Azevan Pharmaceuticals; and he is on the Speakers' Bureau of AstraZeneca, GlaxoSmithKline, Eli Lilly, and Wyeth.
The ocurrence and severity of anxiety disorders have been correlated with fluctuations in female sex steroid levels in both epidemiological and experimental studies.1-5 Female reproductive hormones play a role not only in the development and course of anxiety disorders but also in treatment response.1,2,6-12 This article focuses on the premenstrual exacerbation of anxiety disorders and briefly reviews the biological pathways and physiological mechanisms thought to contribute to the expression of different anxiety disorder subtypes. Female steroid hormone influences on pharmacological properties of psychoactive drugs used to treat anxiety disorders are also addressed, because these may contribute to treatment response in women who experience premenstrual exacerbation of these disorders.
Recommendations for Clinical Practice:
A better clinical practice to manage anxiety disorders would include:
• A careful assessment of sex-specific triggers of anxiety.
• A clinical interview performed on 2 consecutive occasions (1 in the luteal phase and 1 in the follicular phase of the menstrual cycle).
• The use of a diary for at least 1 menstrual cycle to prospectively chart anxiety symptoms and help identify temporal associations with hormonal changes or possible comorbid disorders.
Once treatment is initiated, women with anxiety disorders should be evaluated during the course of the menstrual cycle for continuous effectiveness of their medications. Women who exhibit premenstrual exacerbation of anxiety disorders may respond to increased doses immediately preceding or during the luteal phase.48,59 Progesterone augmentation may be a therapeutic option for women with anxiety disorders who do not respond, or who respond only partially, to standard therapeutic regimens.2,38
Ms Peer reports that she has no conflicts of interest concerning the subject matter of this article. Dr Soares reports that he has received grant/research support from AstraZeneca and GlaxoSmithKline; he is a consultant for Sepracor, GlaxoSmithKline, Wyeth-Ayerst, and Neurocrine; and he is on the Promotional Speakers' Bureau of GlaxoSmithKline, Wyeth-Ayerst, Forest Laboratories, and Pfizer. Dr Steiner reports that he has received grant/ research support from Wyeth, Pfizer, and AstraZeneca; he is a consultant for Eli Lilly, Pfizer, GlaxoSmithKline, Lundbeck, Novartis, Wyeth, OrthoMcNeil, AstraZeneca, and Azevan Pharmaceuticals; he is on the advisory board of Eli Lilly, GlaxoSmithKline, Pfizer, Lundbeck, OrthoMcNeil, Wyeth, Schering, Ferring, and Azevan Pharmaceuticals; and he is on the Speakers' Bureau of AstraZeneca, GlaxoSmithKline, Eli Lilly, and Wyeth.
The ocurrence and severity of anxiety disorders have been correlated with fluctuations in female sex steroid levels in both epidemiological and experimental studies.1-5 Female reproductive hormones play a role not only in the development and course of anxiety disorders but also in treatment response.1,2,6-12 This article focuses on the premenstrual exacerbation of anxiety disorders and briefly reviews the biological pathways and physiological mechanisms thought to contribute to the expression of different anxiety disorder subtypes. Female steroid hormone influences on pharmacological properties of psychoactive drugs used to treat anxiety disorders are also addressed, because these may contribute to treatment response in women who experience premenstrual exacerbation of these disorders.
Recommendations for Clinical Practice:
A better clinical practice to manage anxiety disorders would include:
• A careful assessment of sex-specific triggers of anxiety.
• A clinical interview performed on 2 consecutive occasions (1 in the luteal phase and 1 in the follicular phase of the menstrual cycle).
• The use of a diary for at least 1 menstrual cycle to prospectively chart anxiety symptoms and help identify temporal associations with hormonal changes or possible comorbid disorders.
Once treatment is initiated, women with anxiety disorders should be evaluated during the course of the menstrual cycle for continuous effectiveness of their medications. Women who exhibit premenstrual exacerbation of anxiety disorders may respond to increased doses immediately preceding or during the luteal phase.48,59 Progesterone augmentation may be a therapeutic option for women with anxiety disorders who do not respond, or who respond only partially, to standard therapeutic regimens.2,38
Friday, November 28, 2008
U.S. researchers call off controversial autism study
Provided by: Associated PressWritten by: THE ASSOCIATED PRESS Sep. 17, 2008
CHICAGO - A government agency in the United States has dropped plans to test a controversial treatment for autism that critics had called an unethical experiment on children.
The National Institute of Mental Health said in a statement Wednesday that the study of chelation (kee-LAY'-shun) has been discontinued. The statement says the agency decided the money would be better used testing other potential therapies for autism and related disorders.
The study had been on hold because of safety concerns . A study published last year linked a chemical used in the treatment to lasting brain problems in rats.
The treatment removes heavy metals from the body and is based on the fringe theory that mercury in vaccines triggers autism - a theory never proved and rejected by mainstream science.
CHICAGO - A government agency in the United States has dropped plans to test a controversial treatment for autism that critics had called an unethical experiment on children.
The National Institute of Mental Health said in a statement Wednesday that the study of chelation (kee-LAY'-shun) has been discontinued. The statement says the agency decided the money would be better used testing other potential therapies for autism and related disorders.
The study had been on hold because of safety concerns . A study published last year linked a chemical used in the treatment to lasting brain problems in rats.
The treatment removes heavy metals from the body and is based on the fringe theory that mercury in vaccines triggers autism - a theory never proved and rejected by mainstream science.
Friday, August 22, 2008
Missing DNA Parts Linked to Schizophrenia Risk
Provided by: Associated PressWritten by: Malcolm Ritter, THE ASSOCIATED PRESS Jul. 30, 2008
NEW YORK - Two huge international studies show that people who lack certain chunks of DNA run a dramatically higher risk of getting schizophrenia, a finding that could help open new doors to understanding and diagnosing the disease.
These deletions are rare, each found in less than one per cent of schizophrenia patients. But each one boosts the risk of disease by as much as 15-fold, by one estimate.
Scientists said studying such abnormalities may help them find new medications by shedding light on what causes the disease. And if enough rare aberrations can be found eventually, they may be combined into a test to help in diagnosis, said Kari Stefansson, chief executive officer of deCode Genetics of Reykjavik, Iceland, and an author of one of the studies.
Schizophrenia is currently diagnosed by its symptoms.
The human DNA can be thought of as a very long string of letters - about three billion of them - that sometimes form words (genes). Each newly identified deletion removes a section of about half a million to two million letters.
In the past, scientists have found specific genes and deletions linked to schizophrenia risk. But the new work is notable because two large studies independently identified the same two DNA deletions, and those aberrations have such a big impact on disease risk. Stefansson's paper also reports evidence for a third deletion.
While the DNA deletions are linked to only a tiny fraction of schizophrenia cases, it's not unusual that a very rare cause of a disease provides insights that apply more generally, said Dr. Pamela Sklar of Massachusetts General Hospital, an author of the other paper. She said such knowledge can lead to treatments for many people.
Both papers were published online Wednesday by the journal Nature. Experts not connected with the work praised the results.
"This is tremendous" for basic research into the disease, said Dr. Linda Brzustowicz of Rutgers University. But since the deletions found so far are related to such a small fraction of schizophrenia cases, she said it's too early for companies to offer to test people for them.
Stefansson's paper, which included authors from more than a dozen centres in the United States, Europe and China, reported findings from DNA tests in about 4,700 people with schizophrenia and more than 40,000 healthy people. Sklar's paper, which included scientists from 11 institutes in the United States, Europe and Australia, tested about 3,400 people with schizophrenia and 3,200 others.
Both papers found that while the deletions were rare in schizophrenia patients, they were even rarer in people without the disease. Scientists say the disease results from a combination of genetic predisposition and environmental influences.
The two deletions found by both research groups boost schizophrenia risk 12-fold and 15-fold, Stefansson's group calculated. A third deletion his group found appears to raise risk about threefold.
Sklar said she was "absolutely delighted" that the papers found the two deletions independently, using different methods.
Anne Pulver, a schizophrenia genetics expert at Johns Hopkins University, said the papers represent a welcome shift in focus for finding genetic variants that affect risk of schizophrenia.
Traditionally, that search has centred on relatively common variants, each with little effect on an individual's risk. The new approach seeks rare variants that play a larger role. The new approach should help identify subgroups of patients with different genetic causes for their disease, she said. Eventually that could lead to treatments that are tailored to the differing biological causes, with improved outcomes, she said.
-
On the Net:
Nature: http://www.nature.com/nature
Information on schizophrenia: http://www.nimh.nih.gov/health/topics/schizophrenia
NEW YORK - Two huge international studies show that people who lack certain chunks of DNA run a dramatically higher risk of getting schizophrenia, a finding that could help open new doors to understanding and diagnosing the disease.
These deletions are rare, each found in less than one per cent of schizophrenia patients. But each one boosts the risk of disease by as much as 15-fold, by one estimate.
Scientists said studying such abnormalities may help them find new medications by shedding light on what causes the disease. And if enough rare aberrations can be found eventually, they may be combined into a test to help in diagnosis, said Kari Stefansson, chief executive officer of deCode Genetics of Reykjavik, Iceland, and an author of one of the studies.
Schizophrenia is currently diagnosed by its symptoms.
The human DNA can be thought of as a very long string of letters - about three billion of them - that sometimes form words (genes). Each newly identified deletion removes a section of about half a million to two million letters.
In the past, scientists have found specific genes and deletions linked to schizophrenia risk. But the new work is notable because two large studies independently identified the same two DNA deletions, and those aberrations have such a big impact on disease risk. Stefansson's paper also reports evidence for a third deletion.
While the DNA deletions are linked to only a tiny fraction of schizophrenia cases, it's not unusual that a very rare cause of a disease provides insights that apply more generally, said Dr. Pamela Sklar of Massachusetts General Hospital, an author of the other paper. She said such knowledge can lead to treatments for many people.
Both papers were published online Wednesday by the journal Nature. Experts not connected with the work praised the results.
"This is tremendous" for basic research into the disease, said Dr. Linda Brzustowicz of Rutgers University. But since the deletions found so far are related to such a small fraction of schizophrenia cases, she said it's too early for companies to offer to test people for them.
Stefansson's paper, which included authors from more than a dozen centres in the United States, Europe and China, reported findings from DNA tests in about 4,700 people with schizophrenia and more than 40,000 healthy people. Sklar's paper, which included scientists from 11 institutes in the United States, Europe and Australia, tested about 3,400 people with schizophrenia and 3,200 others.
Both papers found that while the deletions were rare in schizophrenia patients, they were even rarer in people without the disease. Scientists say the disease results from a combination of genetic predisposition and environmental influences.
The two deletions found by both research groups boost schizophrenia risk 12-fold and 15-fold, Stefansson's group calculated. A third deletion his group found appears to raise risk about threefold.
Sklar said she was "absolutely delighted" that the papers found the two deletions independently, using different methods.
Anne Pulver, a schizophrenia genetics expert at Johns Hopkins University, said the papers represent a welcome shift in focus for finding genetic variants that affect risk of schizophrenia.
Traditionally, that search has centred on relatively common variants, each with little effect on an individual's risk. The new approach seeks rare variants that play a larger role. The new approach should help identify subgroups of patients with different genetic causes for their disease, she said. Eventually that could lead to treatments that are tailored to the differing biological causes, with improved outcomes, she said.
-
On the Net:
Nature: http://www.nature.com/nature
Information on schizophrenia: http://www.nimh.nih.gov/health/topics/schizophrenia
Sunday, August 10, 2008
A brief overview of Interface Consultation Services current endeavors:
I. Blog Focus - We continue to post weekly on ICS and Counseling Connections.Our posts include mental health research, news and thoughts we feel providers and clients will find valuable.
II. Counseling Connections - Provides Licensed Professional Online and Telephone Mental Health Counseling, Coaching and Services.
III. Telemental Health Triage - We continue our day-to-day service commitment to Riverwood Center to provide professional triage services so their consumers are assured efficient and timely access to mental health services, appropriate level of care assignments and expert telephone crisis triage.
IV. MPRI - Michigan Prisoner Re-entry Initiative for the Mentally Ill - ICS are contracted as the Regional Care Coordinators for the Western Michigan providing services to 18 counties. ICS has hired 5 contracts to assist with this initiative. This program continues to grow at a very fast pace and it the only program of it's kind in the US. This speciality program is designed for mentally ill prisoners who are returning to the community. As Care coordinators we provide funding for housing, psychiatric medications, specialized placements as well as care coordination and consultation on some very difficult cases for the program.
V. Passages - ICS is offering Mobile, Intensive, Short-term, Targeted Case Management Services located in Western Michigan will provide case management service option that requires an immediate, flexible, direct-service and mobile response.
This service is designed to provide the intensity of services needed to the non-severely and persistently mentally ill/indigent population that are currently underserviced or are unable to obtain these services at this time through traditional providers.
VI. Utilization Management Opportunities - We continue to provide acute care preauthorization services for Riverwood Center.
VII. College Level Course - ICS owner/partner, Kathlene LaCour is an part-time facility member at Kalamazoo Valley Community College.Please contact us via email by clicking on the link to learn more about how we can service your consulting needs or call (269)929-1292.
I. Blog Focus - We continue to post weekly on ICS and Counseling Connections.Our posts include mental health research, news and thoughts we feel providers and clients will find valuable.
II. Counseling Connections - Provides Licensed Professional Online and Telephone Mental Health Counseling, Coaching and Services.
III. Telemental Health Triage - We continue our day-to-day service commitment to Riverwood Center to provide professional triage services so their consumers are assured efficient and timely access to mental health services, appropriate level of care assignments and expert telephone crisis triage.
IV. MPRI - Michigan Prisoner Re-entry Initiative for the Mentally Ill - ICS are contracted as the Regional Care Coordinators for the Western Michigan providing services to 18 counties. ICS has hired 5 contracts to assist with this initiative. This program continues to grow at a very fast pace and it the only program of it's kind in the US. This speciality program is designed for mentally ill prisoners who are returning to the community. As Care coordinators we provide funding for housing, psychiatric medications, specialized placements as well as care coordination and consultation on some very difficult cases for the program.
V. Passages - ICS is offering Mobile, Intensive, Short-term, Targeted Case Management Services located in Western Michigan will provide case management service option that requires an immediate, flexible, direct-service and mobile response.
This service is designed to provide the intensity of services needed to the non-severely and persistently mentally ill/indigent population that are currently underserviced or are unable to obtain these services at this time through traditional providers.
VI. Utilization Management Opportunities - We continue to provide acute care preauthorization services for Riverwood Center.
VII. College Level Course - ICS owner/partner, Kathlene LaCour is an part-time facility member at Kalamazoo Valley Community College.Please contact us via email by clicking on the link to learn more about how we can service your consulting needs or call (269)929-1292.
Thursday, May 15, 2008
Men Drink, Women Ruminate Leading to Anxiety and Depression When Stressed
Women and men tend to have different types of stress-related psychological disorders. Women have greater rates of depression and some types of anxiety disorders than men, while men have greater rates of alcohol-use disorders than women. A new study of emotional and alcohol-craving responses to stress has found that when men become upset, they are more likely than women to want alcohol.
"We know that women and men respond to stress differently," said Tara M. Chaplin, associate research scientist at Yale University School of Medicine and first author of the study. "For example, following a stressful experience, women are more likely than men to say that they feel sad or anxious, which may lead to risk for depression and anxiety disorders. Some studies have found that men are more likely to drink alcohol following stress than women. If this becomes a pattern, it could lead to alcohol-use disorders."
As part of a larger study, the researchers exposed 54 healthy adult social drinkers (27 women, 27 men) to three types of imagery scripts - stressful, alcohol-related, and neutral/relaxing - in separate sessions, on separate days and in random order. Chaplin and her colleagues then assessed participants' subjective emotions, behavioral/bodily responses, cardiovascular arousal as indicated by heart rate and blood pressure, and self-reported alcohol craving.
"After listening to the stressful story, women reported more sadness and anxiety than men," said Chaplin, "as well as greater behavioral arousal. But, for the men ... emotional arousal was linked to increases in alcohol craving. In other words, when men are upset, they are more likely to want alcohol."
These findings - in addition to the fact that the men drank more than the women on average - meant that the men had more experience with alcohol, perhaps leading them to turn to alcohol as a way of coping with distress, added Chaplin. "Men's tendency to crave alcohol when upset may be a learned behavior or may be related to known gender differences in reward pathways in the brain," she said. "And this tendency may contribute to risk for alcohol-use disorders."
There is a greater societal acceptance of "emotionality," particularly sadness and anxiety, in women than in men, noted Chaplin.
"Women are more likely than men to focus on negative emotional aspects of stressful circumstances, for example, they tend to 'ruminate' or think over and over again about their negative emotional state," she said. "Men, in contrast, are more likely to distract themselves from negative emotions, to try not to think about these emotions. Our finding that men had greater blood pressure response to stress, but did not report greater sadness and anxiety, may reflect that they are more likely to try to distract themselves from their physiological arousal, possibly through the use of alcohol."
Chaplin TM, Hong K, Bergquist K, Sinha R. Gender Differences in Response to Emotional Stress: An Assessment Across Subjective, Behavioral, and Physiological Domains and Relations to Alcohol Craving. Alcohol Clin Exp Res. 2008;doi: 10.1111/j.1530-0277.2008.00679.x [Abstract]
"We know that women and men respond to stress differently," said Tara M. Chaplin, associate research scientist at Yale University School of Medicine and first author of the study. "For example, following a stressful experience, women are more likely than men to say that they feel sad or anxious, which may lead to risk for depression and anxiety disorders. Some studies have found that men are more likely to drink alcohol following stress than women. If this becomes a pattern, it could lead to alcohol-use disorders."
As part of a larger study, the researchers exposed 54 healthy adult social drinkers (27 women, 27 men) to three types of imagery scripts - stressful, alcohol-related, and neutral/relaxing - in separate sessions, on separate days and in random order. Chaplin and her colleagues then assessed participants' subjective emotions, behavioral/bodily responses, cardiovascular arousal as indicated by heart rate and blood pressure, and self-reported alcohol craving.
"After listening to the stressful story, women reported more sadness and anxiety than men," said Chaplin, "as well as greater behavioral arousal. But, for the men ... emotional arousal was linked to increases in alcohol craving. In other words, when men are upset, they are more likely to want alcohol."
These findings - in addition to the fact that the men drank more than the women on average - meant that the men had more experience with alcohol, perhaps leading them to turn to alcohol as a way of coping with distress, added Chaplin. "Men's tendency to crave alcohol when upset may be a learned behavior or may be related to known gender differences in reward pathways in the brain," she said. "And this tendency may contribute to risk for alcohol-use disorders."
There is a greater societal acceptance of "emotionality," particularly sadness and anxiety, in women than in men, noted Chaplin.
"Women are more likely than men to focus on negative emotional aspects of stressful circumstances, for example, they tend to 'ruminate' or think over and over again about their negative emotional state," she said. "Men, in contrast, are more likely to distract themselves from negative emotions, to try not to think about these emotions. Our finding that men had greater blood pressure response to stress, but did not report greater sadness and anxiety, may reflect that they are more likely to try to distract themselves from their physiological arousal, possibly through the use of alcohol."
Chaplin TM, Hong K, Bergquist K, Sinha R. Gender Differences in Response to Emotional Stress: An Assessment Across Subjective, Behavioral, and Physiological Domains and Relations to Alcohol Craving. Alcohol Clin Exp Res. 2008;doi: 10.1111/j.1530-0277.2008.00679.x [Abstract]
Sunday, April 20, 2008
Research on Effectiveness of Psychotherapies for Children
The National Instititute of Mental Health has completed en evaluation of research and the effectiveness for mental disorders for children. Please see NIMH site and below..
Reviews of the current research on psychosocial and behavioral therapies, or psychotherapies, for children and adolescents found a number of "well established" and "probably efficacious" treatments for many mental disorders. For example, six were "probably efficacious" for anxiety disorders, and two were "well established" for attention deficit hyperactivity disorder (ADHD), according to scientists funded by NIMH and the National Institute on Drug Abuse, divisions of the National Institutes of Health.
The results were published in a special issue of the Journal of Clinical Child and Adolescent Psychology, and cover the current state of research psychotherapies for children and adolescents with mental disorders. NIMH grantees Wendy Silverman, Ph.D., of Florida International University, Miami, and Stephen Hinshaw, Ph.D., of the University of California, Berkeley, served as guest editors. This special issue provides a 10-year update on the original special issue on psychosocial treatments, published in 1998."
Even for the most effective interventions, there is substantial individual variability in treatment response," said Benedetto Vitiello, chief of NIMH's Child and Adolescent Treatment and Preventive Intervention Research Branch. "Further research is needed to understand the factors accounting for treatment effects and to identify predictors of response, in order to eventually arrive at more targeted and specific intervention strategies."
Overall, the 10 articles in the special issue reveal considerable advances over the past decade in the quality and quantity of research on psychosocial treatments for children with mental disorders.
Among notable findings:A review of 32 studies by Silverman and her colleagues concluded that six therapies for anxiety disorders have substantial research support and met the criteria for "probably efficacious" and may be helpful for treating children and adolescents with anxiety disorders. These treatments are:
Individual cognitive behavioral therapy.
Group cognitive behavioral therapy (GCBT).
GCBT with parents.GCBT for social phobia.
Social effectiveness training for children with social phobia.Few large-scale trials on anxiety disorders have compared specific psychosocial therapies with credible control conditions. As a result, to date, no specific psychotherapies met the most stringent criteria for "well-established treatments" used for this article. However, the second-highest ranking of "probably efficacious" denotes considerable research evidence supporting a treatment's usefulness, so mental health care providers can be confident in using the therapies listed, Silverman says.
A review of 46 studies by William Pelham, Jr., Ph.D., and Gregory Fabiano, Ph.D., both of the State University of New York at Buffalo, found that two psychosocial treatments are "well-established" for treating ADHD in children and adolescents:
Behavioral parent training.
Behavioral classroom management.
The authors also found a third type of well-established behavioral intervention called the Summer Treatment Program (STP), which focuses on peer relationships and is often given in recreational, summer camp-like settings. Children in STP typically receive more hours of treatment in a week compared to other weekly forms of psychotherapy, but STP is more expensive, and harder to provide in the community, and harder to find than behavioral parent training and behavioral classroom management.
In addition to anxiety and ADHD, the special issue also evaluates evidence-based psychosocial treatments for autism, eating disorders, depression, obsessive-compulsive disorder, exposure to traumatic events, disruptive behavior, and substance abuse. In addition, one of the articles focused on psychotherapies and treatment approaches specific to different ethnic and cultural backgrounds.
Mental disorders are generally treated with psychotherapy, medications, or a combination of the two. As scientists find out more about how mental disorders affect the brain and behavior, they also better understand what makes a treatment work for certain disorders or certain people. This can sometimes lead to new medications or therapies, or new uses for existing treatments. However, such treatments may not be proven by research (evidence-based).
The special issue helps address knowledge gaps by reporting on the current state of evidence-based psychosocial treatments in children and adolescents. For each article, scientists provided a review of the research literature in their field of expertise. The articles also:Identify the most effective psychosocial treatments, using and building on guidelines developed in 1995 by the American Psychological Association Task Force on Promotion and Dissemination of Psychological Procedures.
Discuss factors that may affect a child's response to treatment.Suggest directions for future research.Each article also discusses practice recommendations based on available research for doctors and other mental health care providers. However, these recommendations are intended more as a guide to current treatments and are not a requirement or prescription for best care."
We can only hope that the current generation of child and adolescent psychosocial treatment researchers will heed the call expressed in these articles for even more sophisticated, more rigorous, and more statistically powerful studies," said Drs. Silverman and Hinshaw.
Reference
Silverman WK, Hinshaw SP. The Second Special Issue on Evidence-Based Psychosocial Treatments for Children and Adolescents: A Ten-Year Update. J Clin Child Adolesc Psychol. 2008 Jan-Mar;37(1)
Reviews of the current research on psychosocial and behavioral therapies, or psychotherapies, for children and adolescents found a number of "well established" and "probably efficacious" treatments for many mental disorders. For example, six were "probably efficacious" for anxiety disorders, and two were "well established" for attention deficit hyperactivity disorder (ADHD), according to scientists funded by NIMH and the National Institute on Drug Abuse, divisions of the National Institutes of Health.
The results were published in a special issue of the Journal of Clinical Child and Adolescent Psychology, and cover the current state of research psychotherapies for children and adolescents with mental disorders. NIMH grantees Wendy Silverman, Ph.D., of Florida International University, Miami, and Stephen Hinshaw, Ph.D., of the University of California, Berkeley, served as guest editors. This special issue provides a 10-year update on the original special issue on psychosocial treatments, published in 1998."
Even for the most effective interventions, there is substantial individual variability in treatment response," said Benedetto Vitiello, chief of NIMH's Child and Adolescent Treatment and Preventive Intervention Research Branch. "Further research is needed to understand the factors accounting for treatment effects and to identify predictors of response, in order to eventually arrive at more targeted and specific intervention strategies."
Overall, the 10 articles in the special issue reveal considerable advances over the past decade in the quality and quantity of research on psychosocial treatments for children with mental disorders.
Among notable findings:A review of 32 studies by Silverman and her colleagues concluded that six therapies for anxiety disorders have substantial research support and met the criteria for "probably efficacious" and may be helpful for treating children and adolescents with anxiety disorders. These treatments are:
Individual cognitive behavioral therapy.
Group cognitive behavioral therapy (GCBT).
GCBT with parents.GCBT for social phobia.
Social effectiveness training for children with social phobia.Few large-scale trials on anxiety disorders have compared specific psychosocial therapies with credible control conditions. As a result, to date, no specific psychotherapies met the most stringent criteria for "well-established treatments" used for this article. However, the second-highest ranking of "probably efficacious" denotes considerable research evidence supporting a treatment's usefulness, so mental health care providers can be confident in using the therapies listed, Silverman says.
A review of 46 studies by William Pelham, Jr., Ph.D., and Gregory Fabiano, Ph.D., both of the State University of New York at Buffalo, found that two psychosocial treatments are "well-established" for treating ADHD in children and adolescents:
Behavioral parent training.
Behavioral classroom management.
The authors also found a third type of well-established behavioral intervention called the Summer Treatment Program (STP), which focuses on peer relationships and is often given in recreational, summer camp-like settings. Children in STP typically receive more hours of treatment in a week compared to other weekly forms of psychotherapy, but STP is more expensive, and harder to provide in the community, and harder to find than behavioral parent training and behavioral classroom management.
In addition to anxiety and ADHD, the special issue also evaluates evidence-based psychosocial treatments for autism, eating disorders, depression, obsessive-compulsive disorder, exposure to traumatic events, disruptive behavior, and substance abuse. In addition, one of the articles focused on psychotherapies and treatment approaches specific to different ethnic and cultural backgrounds.
Mental disorders are generally treated with psychotherapy, medications, or a combination of the two. As scientists find out more about how mental disorders affect the brain and behavior, they also better understand what makes a treatment work for certain disorders or certain people. This can sometimes lead to new medications or therapies, or new uses for existing treatments. However, such treatments may not be proven by research (evidence-based).
The special issue helps address knowledge gaps by reporting on the current state of evidence-based psychosocial treatments in children and adolescents. For each article, scientists provided a review of the research literature in their field of expertise. The articles also:Identify the most effective psychosocial treatments, using and building on guidelines developed in 1995 by the American Psychological Association Task Force on Promotion and Dissemination of Psychological Procedures.
Discuss factors that may affect a child's response to treatment.Suggest directions for future research.Each article also discusses practice recommendations based on available research for doctors and other mental health care providers. However, these recommendations are intended more as a guide to current treatments and are not a requirement or prescription for best care."
We can only hope that the current generation of child and adolescent psychosocial treatment researchers will heed the call expressed in these articles for even more sophisticated, more rigorous, and more statistically powerful studies," said Drs. Silverman and Hinshaw.
Reference
Silverman WK, Hinshaw SP. The Second Special Issue on Evidence-Based Psychosocial Treatments for Children and Adolescents: A Ten-Year Update. J Clin Child Adolesc Psychol. 2008 Jan-Mar;37(1)
Monday, January 21, 2008
Our Deepest Fear.......MLK Day!
Our deepest fear is not that we are inadequate.
Our deepest fear is that we are powerful beyond measure.
We ask ourselves, Who am I to be brilliant, gorgeous, talented, fabulous?
Actually, who are you not to be?
We were born to make manifest the glory of God that is within us.
And as we let our own light shine, we unconsciously give other people permission to do the same.
-Martin Luther King, Jr.
Our deepest fear is that we are powerful beyond measure.
We ask ourselves, Who am I to be brilliant, gorgeous, talented, fabulous?
Actually, who are you not to be?
We were born to make manifest the glory of God that is within us.
And as we let our own light shine, we unconsciously give other people permission to do the same.
-Martin Luther King, Jr.
Sunday, December 30, 2007
Teen Brain Still Maturing
Provided by: Associated Press
Written by: Malcolm Ritter, THE ASSOCIATED PRESS Dec. 2, 2007
NEW YORK - The teenage brain, Laurence Steinberg says, is like a car with a good accelerator but a weak brake. With powerful impulses under poor control, the likely result is a crash.
And, perhaps, a crime.
Steinberg, a Temple University psychology professor, helped draft an American Psychological Association brief for a 2005 case in which the U.S. Supreme Court outlawed the death penalty for crimes committed before age 18.
That ruling relies on the most recent research on the adolescent brain, which indicates the juvenile brain is still maturing in the teen years and reasoning and judgment are developing well into the early to mid 20s. It is often cited as state legislators consider scaling back punitive juvenile justice laws passed during the 1990s.
"As any parent knows," wrote Justice Anthony Kennedy for the 5-4 majority, youths are more likely to show "a lack of maturity and an underdeveloped sense of responsibility" than adults. "These qualities often result in impetuous and ill-considered actions and decisions."
He also noted that "juveniles are more vulnerable or susceptible to negative influences and outside pressures, including peer pressure," causing them to have less control over their environment.
Some child advocates have pointed to the Supreme Court decision and the research as evidence that teens - even those accused of serious crimes - should not be regarded in the same way as adults in the criminal justice system.
Dr. David Fassler, a psychiatry professor at the University of Vermont College of Medicine who has testified before legislative committees on brain development, says the research doesn't absolve teens but offers some explanation for their behavior.
"It doesn't mean adolescents can't make a rational decision or appreciate the difference between right and wrong," he said. "It does mean, particularly when confronted with stressful or emotional decisions, they are more likely to act impulsively, on instinct, without fully understanding or analyzing the consequences of their actions."
Experts say that even at ages 16 and 17, when compared to adults, juveniles on average are more:
-impulsive.
-aggressive.
-emotionally volatile.
-likely to take risks.
-reactive to stress.
-vulnerable to peer pressure.
-prone to focus on and overestimate short-term payoffs and underplay longer-term consequences of what they do.
-likely to overlook alternative courses of action.
Violence toward others also tends to peak in adolescent years, says psychiatrist Dr. Peter Ash of Emory University. It's mostly likely to start around age 16, and people who haven't committed a violent crime by age 19 only rarely start doing it later, he said.
The good news here, he said, is that a violent adolescent doesn't necessarily become a violent adult. Some two-thirds to three-quarters of violent youth grow out of it, he said. "They get more self-controlled."
Some of the changes found in behavioral studies are paralleled by changes in the brain itself as youths become adults.
In fact, in just the past few years, Steinberg said, brain scans have given biological backing to commonsense notions about teen behavior, like their impulsiveness and vulnerability to peer pressure.
It's one thing to say teens don't control their impulses as well as adults, but another to show that they can't, he said. As for peer pressure, the new brain research "gives credence to the idea that this isn't a choice that kids are making to give in to their friends, that biologically, they're more vulnerable to that," he said.
Consider the lobes at the front of the brain. The nerve circuitry here ties together inputs from other parts of the brain, said Dr. Jay Giedd of the National Institute of Mental Health.
This circuitry weighs how much priority to give incoming messages like "Do this now" versus "Wait! What about the consequences?" In short, the frontal lobes are key for making good decisions and controlling impulses.
Brain scans show that the frontal lobes don't mature until age 25, and their connections to other parts of the brain continue to improve to at least that age, Giedd said.
The inexplicable behavior and poor judgments teens are known for almost always happen when teens are feeling high emotion or intense peer pressure, conditions that overwhelm the still-maturing circuitry in the front part of brain, Giedd said.
Written by: Malcolm Ritter, THE ASSOCIATED PRESS Dec. 2, 2007
NEW YORK - The teenage brain, Laurence Steinberg says, is like a car with a good accelerator but a weak brake. With powerful impulses under poor control, the likely result is a crash.
And, perhaps, a crime.
Steinberg, a Temple University psychology professor, helped draft an American Psychological Association brief for a 2005 case in which the U.S. Supreme Court outlawed the death penalty for crimes committed before age 18.
That ruling relies on the most recent research on the adolescent brain, which indicates the juvenile brain is still maturing in the teen years and reasoning and judgment are developing well into the early to mid 20s. It is often cited as state legislators consider scaling back punitive juvenile justice laws passed during the 1990s.
"As any parent knows," wrote Justice Anthony Kennedy for the 5-4 majority, youths are more likely to show "a lack of maturity and an underdeveloped sense of responsibility" than adults. "These qualities often result in impetuous and ill-considered actions and decisions."
He also noted that "juveniles are more vulnerable or susceptible to negative influences and outside pressures, including peer pressure," causing them to have less control over their environment.
Some child advocates have pointed to the Supreme Court decision and the research as evidence that teens - even those accused of serious crimes - should not be regarded in the same way as adults in the criminal justice system.
Dr. David Fassler, a psychiatry professor at the University of Vermont College of Medicine who has testified before legislative committees on brain development, says the research doesn't absolve teens but offers some explanation for their behavior.
"It doesn't mean adolescents can't make a rational decision or appreciate the difference between right and wrong," he said. "It does mean, particularly when confronted with stressful or emotional decisions, they are more likely to act impulsively, on instinct, without fully understanding or analyzing the consequences of their actions."
Experts say that even at ages 16 and 17, when compared to adults, juveniles on average are more:
-impulsive.
-aggressive.
-emotionally volatile.
-likely to take risks.
-reactive to stress.
-vulnerable to peer pressure.
-prone to focus on and overestimate short-term payoffs and underplay longer-term consequences of what they do.
-likely to overlook alternative courses of action.
Violence toward others also tends to peak in adolescent years, says psychiatrist Dr. Peter Ash of Emory University. It's mostly likely to start around age 16, and people who haven't committed a violent crime by age 19 only rarely start doing it later, he said.
The good news here, he said, is that a violent adolescent doesn't necessarily become a violent adult. Some two-thirds to three-quarters of violent youth grow out of it, he said. "They get more self-controlled."
Some of the changes found in behavioral studies are paralleled by changes in the brain itself as youths become adults.
In fact, in just the past few years, Steinberg said, brain scans have given biological backing to commonsense notions about teen behavior, like their impulsiveness and vulnerability to peer pressure.
It's one thing to say teens don't control their impulses as well as adults, but another to show that they can't, he said. As for peer pressure, the new brain research "gives credence to the idea that this isn't a choice that kids are making to give in to their friends, that biologically, they're more vulnerable to that," he said.
Consider the lobes at the front of the brain. The nerve circuitry here ties together inputs from other parts of the brain, said Dr. Jay Giedd of the National Institute of Mental Health.
This circuitry weighs how much priority to give incoming messages like "Do this now" versus "Wait! What about the consequences?" In short, the frontal lobes are key for making good decisions and controlling impulses.
Brain scans show that the frontal lobes don't mature until age 25, and their connections to other parts of the brain continue to improve to at least that age, Giedd said.
The inexplicable behavior and poor judgments teens are known for almost always happen when teens are feeling high emotion or intense peer pressure, conditions that overwhelm the still-maturing circuitry in the front part of brain, Giedd said.
Saturday, October 20, 2007
Personal Care, Restaurant Industries Have Highest Depression Rates
Provided by: Associated PressWritten by: Kevin Freking, THE ASSOCIATED PRESS Oct. 13, 2007 and Conoe News
WASHINGTON - People who tend to the elderly, change diapers and serve up food and drinks have the highest rates of depression among U.S. workers.
Overall, seven per cent of full-time workers battled depression in the past year, according to a government report available Saturday.
Women were more likely than men to have had a major bout of depression, and younger workers had higher rates of depression than their older colleagues.
Almost 11 per cent of personal care workers - which includes child care and helping the elderly and severely disabled with their daily needs - reported depression lasting two weeks or longer.
During such episodes there is loss of interest and pleasure, and at least four other symptoms surface, including problems with sleep, eating, energy, concentration and self-image.
Workers who prepare and serve food - cooks, bartenders, waiters and waitresses - had the second highest rate of depression among full-time employees at 10.3 per cent.
In a tie for third were health care workers and social workers at 9.6 per cent.
The lowest rate of depression, 4.3 per cent, occurred in the job category that covers engineers, architects and surveyors.
Government officials tracked depression within 21 major occupational categories. They combined data from 2004 through 2006 to estimate episodes of depression within the past year. That information came from the National Survey on Drug Use and Health, which registers lifetime and past-year depression bouts.
Depression leads to $30 billion to $44 billion in lost productivity annually, said the report from the Substance Abuse and Mental Health Services Administration.
The report was available Saturday on the agency's website at http://oas.samhsa.gov/
The various job categories tracked could be quite broad, with employees grouped in the same category seemingly having little in common.
For example, one category included workers in the arts, media, entertainment and sports. In the personal care category, a worker caring for toddlers at a daycare centre would have quite a different job from a nursing aide who helps an older person live at home rather than in a nursing home.
Just working full-time would appear to be beneficial in preventing depression. The overall rate of depression for full-time workers, seven per cent, compares with the 12.7 per cent rate registered by those who are unemployed.
The percentage of full-time workers age 18 to 64 reporting depression lasting two weeks or longer, by categories of occupation, as provided by the National Survey on Drug Use and Health using 2004 through 2006 data:
-Personal care and service: 10.8
-Food preparation and serving related: 10.3
-Community and social services: 9.6
-Health care practitioners and technical: 9.6
-Arts, design, entertainment, sports and media: 9.1
-Education, training and library: 8.7
-Office and administrative support: 8.1
-Building and grounds cleaning and maintenance: 7.3
-Financial: 6.7
-Sales and related: 6.7
-Legal: 6.4
-Transportation and material moving: 6.4
-Mathematical and computer scientists: 6.2
-Production: 5.9
-Management: 5.8
-Farming, fishing and forestry: 5.6
-Protective service: 5.5
-Construction and extraction: 4.8
-Installation, maintenance and repair: 4.4
-Life, physical and social science: 4.4
-Engineering, architecture and surveyors: 4.3
Source: Substance Abuse and Mental Health Services Administration.
WASHINGTON - People who tend to the elderly, change diapers and serve up food and drinks have the highest rates of depression among U.S. workers.
Overall, seven per cent of full-time workers battled depression in the past year, according to a government report available Saturday.
Women were more likely than men to have had a major bout of depression, and younger workers had higher rates of depression than their older colleagues.
Almost 11 per cent of personal care workers - which includes child care and helping the elderly and severely disabled with their daily needs - reported depression lasting two weeks or longer.
During such episodes there is loss of interest and pleasure, and at least four other symptoms surface, including problems with sleep, eating, energy, concentration and self-image.
Workers who prepare and serve food - cooks, bartenders, waiters and waitresses - had the second highest rate of depression among full-time employees at 10.3 per cent.
In a tie for third were health care workers and social workers at 9.6 per cent.
The lowest rate of depression, 4.3 per cent, occurred in the job category that covers engineers, architects and surveyors.
Government officials tracked depression within 21 major occupational categories. They combined data from 2004 through 2006 to estimate episodes of depression within the past year. That information came from the National Survey on Drug Use and Health, which registers lifetime and past-year depression bouts.
Depression leads to $30 billion to $44 billion in lost productivity annually, said the report from the Substance Abuse and Mental Health Services Administration.
The report was available Saturday on the agency's website at http://oas.samhsa.gov/
The various job categories tracked could be quite broad, with employees grouped in the same category seemingly having little in common.
For example, one category included workers in the arts, media, entertainment and sports. In the personal care category, a worker caring for toddlers at a daycare centre would have quite a different job from a nursing aide who helps an older person live at home rather than in a nursing home.
Just working full-time would appear to be beneficial in preventing depression. The overall rate of depression for full-time workers, seven per cent, compares with the 12.7 per cent rate registered by those who are unemployed.
The percentage of full-time workers age 18 to 64 reporting depression lasting two weeks or longer, by categories of occupation, as provided by the National Survey on Drug Use and Health using 2004 through 2006 data:
-Personal care and service: 10.8
-Food preparation and serving related: 10.3
-Community and social services: 9.6
-Health care practitioners and technical: 9.6
-Arts, design, entertainment, sports and media: 9.1
-Education, training and library: 8.7
-Office and administrative support: 8.1
-Building and grounds cleaning and maintenance: 7.3
-Financial: 6.7
-Sales and related: 6.7
-Legal: 6.4
-Transportation and material moving: 6.4
-Mathematical and computer scientists: 6.2
-Production: 5.9
-Management: 5.8
-Farming, fishing and forestry: 5.6
-Protective service: 5.5
-Construction and extraction: 4.8
-Installation, maintenance and repair: 4.4
-Life, physical and social science: 4.4
-Engineering, architecture and surveyors: 4.3
Source: Substance Abuse and Mental Health Services Administration.
Friday, September 07, 2007
Late Night Teen Cell Phone Use Threat to Sleep and Functioning
Psychiatric Times
Judith GrochReviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
Explain to interested patients that teenage use of cell phones for calling and text messaging is common after bedtime, leaving adolescents sleep-deprived and tired.
LEUVEN, Belgium, Sept. 4 -- Just because adolescents go to bed, that doesn't mean they stop calling and texting their friends, and that may leave them bleary-eyed in the morning, researchers here reported.
Adolescents who use their mobile phones for calling friends and sending and receiving text messages after bedtime awaken sleep-deprived and tired, Jan Van den Bulck, Ph.D., of Katholieke Universiteit Leuven here, reported in the Sept. 1 issue of Sleep.
Heavy use of TV, internet, and computer games in the bedroom has been linked to reduced time in bed and to sleep disturbances, although adolescents often claim they need these media as "sleep aids."
Much of the teen use of cell phones involves the simple pleasure of being permanently connected, day and night, to a group of friends, Dr. Van den Bulck said. However, he added, little has been known about the impact of cell phone use on sleep.
To assess the prevalence of night-time mobile phone use and its relationship to tiredness with a one-year follow-up, Dr. Van den Bulck studied 1,656 second-year and fifth-year secondary school children in 15 schools in Flanders.
Baseline data were collected in February 2003 with a follow-up in 2004 and another in 2005.
Of the children (52.1% boys), the average age was 13.7 years in the youngest group and 16.9 years in the oldest group at baseline. Tiredness was self-reported.
Only 38% of the participants never used their mobile phone after lights out. Overall 35% of the cases of being very tired were attributed to the use of the mobile phone.
Multinomial logistic regression showed that after a year:
Using the mobile phone less often than once a month increased the odds of being very tired by 1.8 (95% CI 1.2 - 2.8);
Using the phone less than once a week more than doubled the tiredness odds (OR 2.2, 95% CI 1.4 - 3.5);
Using it about once a week tripled the odds (OR 3.3, CI 1.9 - 5.7);
Using it several times a week yielded a five-fold increase in the odds of being very tired (OR 5.1, CI 2.5 - 10.4).
Time of calling, ranging from right after bedtime to any time of the night, also made a difference in the one-year tiredness measure. In most cases calling happened right after lights out. Yet a considerable amount occurred before 3 AM, and about a fifth of the adolescents reported that sending or calling could happen at any time of night.
Use of the phone right after lights out increased the odds of being very tired by 2.2 (CI 1.4 - 3.4); between lights out and 3 AM, the odds were 3.9 times higher (CI 2.1 - 7.1), and for those who used it at any time of the night the odds were 3.3 times higher (CI 1.8 - 6.0).
Among the study's limitations was the use of self-reports. Usually giving socially desirable replies, a potential source of bias in such studies, would not seem to have occurred here, as it is unlikely that students believe that underestimating this behavior is socially desirable.
It is also customary to warn readers about drawing causal conclusions from this sort of research, Dr. Van den Bulck said. However, the idea that adolescents use their phones because they can't sleep does not hold here because of the two-way communication involved. It would apply to outgoing calls, but not to incoming calls.
Unless there were clusters of sleepless adolescents, it is more likely that communicating children keep each other awake, Dr. Van den Bulck wrote.
Mobile-phone use after lights out is widespread, he said. The risk ratios suggest that there is no safe dose. Even moderate use doubles the risk of long term tiredness, nor is there is a safe time to send or receive calls or messages.
There is growing awareness of the importance of studying the impact of the modern electronic media on several aspects of adolescent health in general and sleep in particular, Dr. Van den Bulck said.
The American Academy of Pediatrics has suggested that children's bedrooms ought to be "electronic media-free." However, the Academy appeared to be thinking mainly of media such as TV and video games, he said.
However, the present study suggests that there are many more threats to adolescent sleep in the bedroom. As mobile phones become ever more complex (integrating radio, television, and MP3 technologies), the attraction to use them after lights out is likely to increase further, Dr. Van den Bulck concluded.
Dr. Van den Bulck reported no conflicts of interest. This study received support from the Fund for Scientific Research (Flanders) and the Ministry of Welfare of the Flemish Government of Belgium.
Judith GrochReviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
Explain to interested patients that teenage use of cell phones for calling and text messaging is common after bedtime, leaving adolescents sleep-deprived and tired.
LEUVEN, Belgium, Sept. 4 -- Just because adolescents go to bed, that doesn't mean they stop calling and texting their friends, and that may leave them bleary-eyed in the morning, researchers here reported.
Adolescents who use their mobile phones for calling friends and sending and receiving text messages after bedtime awaken sleep-deprived and tired, Jan Van den Bulck, Ph.D., of Katholieke Universiteit Leuven here, reported in the Sept. 1 issue of Sleep.
Heavy use of TV, internet, and computer games in the bedroom has been linked to reduced time in bed and to sleep disturbances, although adolescents often claim they need these media as "sleep aids."
Much of the teen use of cell phones involves the simple pleasure of being permanently connected, day and night, to a group of friends, Dr. Van den Bulck said. However, he added, little has been known about the impact of cell phone use on sleep.
To assess the prevalence of night-time mobile phone use and its relationship to tiredness with a one-year follow-up, Dr. Van den Bulck studied 1,656 second-year and fifth-year secondary school children in 15 schools in Flanders.
Baseline data were collected in February 2003 with a follow-up in 2004 and another in 2005.
Of the children (52.1% boys), the average age was 13.7 years in the youngest group and 16.9 years in the oldest group at baseline. Tiredness was self-reported.
Only 38% of the participants never used their mobile phone after lights out. Overall 35% of the cases of being very tired were attributed to the use of the mobile phone.
Multinomial logistic regression showed that after a year:
Using the mobile phone less often than once a month increased the odds of being very tired by 1.8 (95% CI 1.2 - 2.8);
Using the phone less than once a week more than doubled the tiredness odds (OR 2.2, 95% CI 1.4 - 3.5);
Using it about once a week tripled the odds (OR 3.3, CI 1.9 - 5.7);
Using it several times a week yielded a five-fold increase in the odds of being very tired (OR 5.1, CI 2.5 - 10.4).
Time of calling, ranging from right after bedtime to any time of the night, also made a difference in the one-year tiredness measure. In most cases calling happened right after lights out. Yet a considerable amount occurred before 3 AM, and about a fifth of the adolescents reported that sending or calling could happen at any time of night.
Use of the phone right after lights out increased the odds of being very tired by 2.2 (CI 1.4 - 3.4); between lights out and 3 AM, the odds were 3.9 times higher (CI 2.1 - 7.1), and for those who used it at any time of the night the odds were 3.3 times higher (CI 1.8 - 6.0).
Among the study's limitations was the use of self-reports. Usually giving socially desirable replies, a potential source of bias in such studies, would not seem to have occurred here, as it is unlikely that students believe that underestimating this behavior is socially desirable.
It is also customary to warn readers about drawing causal conclusions from this sort of research, Dr. Van den Bulck said. However, the idea that adolescents use their phones because they can't sleep does not hold here because of the two-way communication involved. It would apply to outgoing calls, but not to incoming calls.
Unless there were clusters of sleepless adolescents, it is more likely that communicating children keep each other awake, Dr. Van den Bulck wrote.
Mobile-phone use after lights out is widespread, he said. The risk ratios suggest that there is no safe dose. Even moderate use doubles the risk of long term tiredness, nor is there is a safe time to send or receive calls or messages.
There is growing awareness of the importance of studying the impact of the modern electronic media on several aspects of adolescent health in general and sleep in particular, Dr. Van den Bulck said.
The American Academy of Pediatrics has suggested that children's bedrooms ought to be "electronic media-free." However, the Academy appeared to be thinking mainly of media such as TV and video games, he said.
However, the present study suggests that there are many more threats to adolescent sleep in the bedroom. As mobile phones become ever more complex (integrating radio, television, and MP3 technologies), the attraction to use them after lights out is likely to increase further, Dr. Van den Bulck concluded.
Dr. Van den Bulck reported no conflicts of interest. This study received support from the Fund for Scientific Research (Flanders) and the Ministry of Welfare of the Flemish Government of Belgium.
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