September 5, 2018 by Arefa Cassoobhoy, MD, MPH | Medscape
More Bad News About Benzos
(Medscape) – Hello. I’m Dr Arefa Cassoobhoy, a practicing internist, Medscape advisor, and senior medical director for WebMD.
Benzodiazepines are in the news again—this time, not for the increased risk for falls and fractures that can come with their use.
A case-control study was conducted in Finland among community-dwelling adults who had been diagnosed with Alzheimer disease. Benzodiazepines and related Z drug use was associated with a modestly increased risk for Alzheimer disease. No real differences were seen for the drug subcategories. This included short-, medium-, and long-acting benzodiazepines, as well as zolpidem, zaleplon, and eszopiclone.
The analysis showed that 5.7% of dementia cases among adults using benzodiazepines were due to the drugs. Even this small increased risk could be significant because they are widely prescribed to elderly adults, often long term. The drugs are given to treat prodromal and neuropsychiatric symptoms of dementia like insomnia and anxiety.
The authors concluded that benzodiazepines and Z drugs should be avoided when possible, given their adverse-event profile. For patients who you would like to wean off benzodiazepines, deprescribing can be tough and take a long time. Guidelines are now available to help you with the process.
When Rain Comes, Words Are Unnecessary: Our Search for a Better Way
Living in New Mexico means hoping for rain. The state is in drought, with most areas officially in either “extreme” or “exceptional” drought. The soil is full of life waiting for a chance to express itself, but the rare rain forecasts usually promise only “scattered showers nearby,” with the outcome being either clear blue skies or the sight of rain falling elsewhere. New Mexico is also one of the poorest states in the U.S., with more than one in five New Mexicans, and one in four children, living in poverty. We are second in the nation for the prevalence of youth living without connection to work, school, or family. New Mexico ranks high (#7) for people living with serious mental and emotional challenges.
July 9, 2018 by Laysha Ostrow, Patricia B. Nemec, Carina Smith | The Journal of Behavioral Health Services & Research
Self-Employment for People with Psychiatric Disabilities: Advantages and Strategies
(The Journal of Behavioral Health Services & Research) –
Self-employment is an alternative to wage employment and an opportunity to increase labor force participation by people with psychiatric disabilities. Self-employment refers to individuals who work for themselves, either as an unincorporated sole proprietor or through ownership of a business. Advantages of self-employment for people with psychiatric disabilities, who may have disrupted educational and employment histories, include opportunities for self-care, additional earning, and career choice. Self-employment fits within a recovery paradigm because of the value placed on individual preferences, and the role of resilience and perseverance in business ownership. Self-employment creates many new US jobs, but remains only a small percentage of employment closures for people with psychiatric disabilities, despite vocational rehabilitation and Social Security disability policies that encourage it. This commentary elucidates the positive aspects of self-employment in the context of employment challenges experienced by individuals with psychiatric disabilities and provides recommendations based on larger trends in entrepreneurship.
There have been almost 900,000 views of Julia Rucklidge’s 2015 TEDx talk on nutrition and mental health, with many complimentary viewer comments.
Last week, however, the TED organization has inexplicably “flagged” the video with the following comment:
“NOTE FROM TED: We’ve flagged this talk, which was filmed at a TEDx event, because it appears to fall outside TEDx’s curatorial guidelines. There is limited evidence to support the claims made by this speaker.”
Julia has attempted to educate TED staff regarding the fact that over 35 peer-reviewed publications could hardly be described as “limited evidence,” and that her interpretations do not go beyond the data. But so far they are not interested in her evidence.
The whole thing seems so strange: isn’t TED supposed to be all about innovation? But clearly, some lobbyist has convinced them that a non-pharmaceutical treatment should not be respected.
I am asking you to help make this video go viral. That seems to be the only response we can make to such an inappropriate move on TED’s part.
Share it with others, through Facebook or email or Twitter
Ask your friends and colleagues to do the same
Let’s see if we can quadruple the views to 5 million or so.
Dr. Bonnie Kaplan, PhD is the fund advisor of the Nutrition & Mental Health Research Fund and a member of the new International Society for Nutritional Psychiatry Research (ISNPR). For many years, she studied developmental disorders in children, especially ADHD and reading disabilities (dyslexia). Dr. Kaplan was part of a team from University of Calgary and University of British Columbia which helped in the search for genes that predispose children to dyslexia. Also, with her students, she investigated the characteristics of adults with ADHD. Such work led her to further investigations of the role of nutrition. Another interest has been the mood symptoms that accompany ADHD and learning difficulties, and the role of micronutrient treatment of mood, aggression and explosive rage. This progression of topics has resulted in a research program focused on the role of nutrition in brain development and in brain function, especially the use of broad spectrum micronutrient treatment for mental disorders.
Kaplan, B. J., Simpson, J. S. A., Ferre, R. C., Gorman, C. P., McMullen, D. M., & Crawford, S. G. (2001). Effective mood stabilization with a chelated mineral supplement: An open-label trial in bipolar disorder. Journal of Clinical Psychiatry, 62(12), 936-944.
Popper, C. W. (2001). Do vitamins or minerals (apart from lithium) have mood-stabilising effects? Journal of Clinical Psychiatry, 62(12), 933-935.
Kaplan, B. J., Crawford, S. G., Gardner, B., & Farrelly, G. (2002). Treatment of mood lability and explosive rage with minerals and vitamins: two case studies in children. Journal of Child and Adolescent Psychopharmacology, 12(3), 205-219.
Kaplan, B. J., Fisher, J. E., Crawford, S. G., Field, C. J., & Kolb, B. (2004). Improved mood and behavior during treatment with a mineral-vitamin supplement: an open-label case series of children. Journal of Child and Adolescent Psychopharmacology, 14(1), 115-122.
Simmons, M. (2003). Nutritional approach to bipolar disorder. Journal of Clinical Psychiatry, 64(3), 338.
Frazier, E.A., Fristad, M., Arnold, L.E. (2009). Multinutrient Supplement as Treatment: Literature Review and Case Report of a 12-year-old Boy with Bipolar Disorder. Journal of Child and Adolescent Psychopharmacology.19:453-460.
Rucklidge, J. J., & Harrison, R. (2010). Successful treatment of Bipolar Disorder II and ADHD with a micronutrient formula: A case study. CNS Spectrums, 15(5):289-295.
Rucklidge, J. J., Gately, D., & Kaplan, B. J. (2010). Database Analysis of Children and Adolescents with Bipolar Disorder Consuming a Micronutrient Formula. BMC Psychiatry, 10, 17.http://www.biomedcentral.com/1471-244X/10/74
Frazier, E.A., Fristad, M.A. & Arnold, L.E. (2012). Feasibility of a nutritional supplement as treatment for pediatric bipolar spectrum disorders. Journal of Complementary and Alternative Medicine, 18:678-85.
Frazier EA, Gracious B, Arnold LE, Failla M, Chitchumroonchokchai C, Habash D, et al. Nutritional and safety outcomes from an open-label micronutrient intervention for pediatric bipolar spectrum disorders. J Child Adolesc Psychopharmacol2013; 23(8): 558-67.
Retallick-Brown, H., Rucklidge, J. J., & Blampied, N. (2016). Study protocol for a randomised double blind, treatment control trial comparing the efficacy of a micronutrient formula to a single vitamin supplement in the treatment of premenstrual syndrome. Medicines, 3, 32. http://www.mdpi.com/2305-6320/3/4/32
Kimball, S., Mirhosseini, N., & Rucklidge, J. J. (2018). Database Analysis of Depression and Anxiety in a Community Sample—Response to a Micronutrient Intervention. Nutrients, 10(2):152. http://www.mdpi.com/2072-6643/10/2/152
Rucklidge, J. J. (2009). Successful treatment of OCD with a micronutrient formula following partial response to CBT: A case study. Journal of Anxiety Disorders, 23: 836–840.
Rucklidge, J. J., Johnstone, J., Harrison, R., & Boggis, A. (2011). Micronutrients reduce stress and anxiety following a 7.1 earthquake in adults with Attention-Deficit/Hyperactivity Disorder. Psychiatry Research, 189, 281-287. doi:10.1016/j.psychres.2011.06.016
Rucklidge, J. J., Andridge, R., Gorman, B., Blampied, N., Gordon, H. & Boggis, A. (2012). Shaken but unstirred? Effects of micronutrients on stress and trauma after an earthquake: RCT evidence comparing formulas and doses. Human Psychopharmacology: Clinical and Experimental, 27(5), 440-454. https://www.ncbi.nlm.nih.gov/pubmed/22782571
Rucklidge, J. J., Blampied, N., Gorman, B., Gordon, H., & Sole, E. (2014). Psychological functioning one year after a brief intervention using micronutrients to treat stress and anxiety related to the 2011 Christchurch earthquakes: A naturalistic follow-up. Human Psychopharmacology: Clinical and Experimental, 29(3), 230-243. https://www.ncbi.nlm.nih.gov/pubmed/24554519
Sole, E. J., Rucklidge, J. J., & Blampied, N. M. (2017). Anxiety and Stress in Children Following an Earthquake: Clinically Beneficial Effects of Treatment with Micronutrients. Journal of Child and Family Studies, 1-10. doi: 10.1007/s10826-016-0607-2 https://link.springer.com/article/10.1007%2Fs10826-016-0607-2
Kaplan, B. J., Rucklidge, J. J., Romijn, A. R., & Dolph, M. (2015). A randomized trial of nutrient supplements to minimize psychological stress after a natural disaster. Psychiatry Research, 228, 373-379. http://www.ncbi.nlm.nih.gov/pubmed/26154816
Mehl-Madrona, L., Leung, B., Kennedy, C., Paul, S. & Kaplan, B. J. (2010). A naturalistic case-control study of micronutrients versus standard medication management in autism. Journal of Child and Adolescent Psychopharmacology, 20(2):95-103. https://www.ncbi.nlm.nih.gov/pubmed/20415604
Rucklidge, J. J., & Harrison, R. (2010). Successful treatment of Bipolar Disorder II and ADHD with a micronutrient formula: A case study. CNS Spectrums, 15(5):289-295.
Rucklidge, J. J., Taylor, M. R., Whitehead, K. A. (2011). Effect of micronutrients on behaviour and mood in adults with ADHD: Evidence from an 8-week open label trial with natural extension. Journal of Attention Disorders, 15(1), 79-91.
Rucklidge, J. J., Johnstone, J., Harrison, R. (2011). Effect of micronutrients on neurocognitive functioning in adults with ADHD and Severe Mood Dysregulation: A pilot study. Journal of Complementary and Alternative Medicine, 17(12), 1-7. https://www.ncbi.nlm.nih.gov/pubmed/22112202
Rucklidge, J. J., & Blampied, N. M. (2011). Post earthquake functioning in adults with Attention-Deficit/Hyperactivity Disorder: Positive effects of micronutrients on resilience. New Zealand Journal of Psychology, 40(4), 51-57.
Rucklidge, J. J. (2013). Could yeast infections impair recovery from mental illness? A case study using micronutrients and olive leaf extract for the treatment of ADHD and depression. Advances in Mind-Body Medicine, 27(3), 14-18. https://www.ncbi.nlm.nih.gov/pubmed/23784606
Rucklidge, J. J., Johnstone, J., Gorman, B., & Boggis, A., & Frampton, C. (2014). Moderators of treatment response in adults with ADHD to micronutrients: demographics and biomarkers. Progress in Neuro-Psychopharmacology and Biological Psychiatry,50, 163–171. https://www.ncbi.nlm.nih.gov/pubmed/24374068
Gordon, H. A., Rucklidge, J. J., Blampied, N. M., & Johnstone, J. M. (2015). Clinically Significant Symptom Reduction in Children with Attention-Deficit/Hyperactivity Disorder Treated with Micronutrients: An Open-Label Reversal Design Study. Journal of Child and Adolescent Psychopharmacology, 25(10), 783-798. doi: 10.1089/cap.2015.0105 https://www.ncbi.nlm.nih.gov/pubmed/26682999
Rucklidge, J. J., Eggleston, M., Johnstone, J. M., Darling, K., & Frampton, C. M. (2017). Vitamin-mineral treatment improves aggression and emotional regulation in children with ADHD: A fully-blinded, randomized, placebo-controlled trial. Journal of Child Psychology and Psychiatry.http://onlinelibrary.wiley.com/doi/10.1111/jcpp.12817/full
Kaplan, B. J., Isaranuwatchai, W., & Hoch, J. S. (2017). Hospitalization cost of conventional psychiatric care compared to broad-spectrum micronutrient treatment: literature review and case study of adult psychosis. Int J Ment Health Syst, 11, 14. https://link.springer.com/article/10.1186/s13033-017-0122-x
Harrison, R., Rucklidge, J. J., & Blampied, N. (2013). Use of micronutrients attenuates cannabis and nicotine abuse as evidenced from a reversal design: A case study. Journal of Psychoactive Drugs, 45(2), 1-11. https://www.ncbi.nlm.nih.gov/pubmed/23909004
Popper, C. W. (2014). Single-Micronutrient and Broad-Spectrum Micronutrient Approaches for Treating Mood Disorders in Youth and Adults. Child and Adolescent Psychiatric Clinics of North America, 23(3), 591-672. doi: 10.1016/j.chc.2014.04.001
Sarris, J., Logan, A. C., Amminger, G. P., Balanzá-Martínez, V., Freeman, M. P., Hibbeln, J., Matsuoka, Y., Mischoulon, D., Mizoue, T., Nanri, A., Nishi, D., Ramsey, D. Rucklidge, J. J., Sanchez-Villegas, A., Scholey, A., Su, K. P., Jacka, F. N. (2015). Nutritional Medicine as Mainstream in Psychiatry: A Consensus Position Statement from The International Society for Nutritional Psychiatry Research (ISNPR). Lancet Psychiatry, 2, 271-274. http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)00051-0/abstract
Sarris. J., Logan, A. C., Akbaraly, T. N., Amminger, G. P., Balanzá-Martínez, V., Freeman, M. P., Hibbeln, J., Matsuoka, Y., Mischoulon, D., Mizoue, T., Nanri, A., Nishi, D., Parletta, N., Ramsey, D., Rucklidge, J. J., Sanchez-Villegas, A., Scholey, A., Su, C., Jacka, F. N. (2015). The International Society for Nutritional Psychiatry Research (ISNPR) Consensus Position Statement: Nutritional Medicine in Modern Psychiatry (letter to editor). World Psychiatry, 14(3), 370-371. http://onlinelibrary.wiley.com/doi/10.1002/wps.20223/abstract
A study investigating the safety and toxicity of this product shows that, as studied to date, it has not produced any serious adverse effects:
Simpson, J. S. A., Crawford, S. G., Goldstein, E. T., Field, C., Burgess, E., & Kaplan, B. J. (2011). Systematic review of safety and tolerability of a complex micronutrient formula used in mental health. BMC Psychiatry, 11(62). http://www.biomedcentral.com/1471-244X/11/62
So What’s This About Another Webinar Series on Psychiatric Drug Withdrawal?
Some people are asking me, “Why another series of webinars on withdrawing from psychiatric drugs?” That’s a reasonable question given that our first series, Withdrawal from Psychiatric Drugs, covered a lot of territory. We presented general information as well as more specific subjects like wellness, personal experiences, research findings, and the evidence base for drug withdrawal.
But this subject is a complex one, and our first course was just our start in exploring this topic. With this second course we are focusing on the challenges that drug withdrawal presents to prescribers.
As many have noted, prescribers may have extensive experience getting patients on psychiatric medications and then managing their drug use, but little or no experience helping patients taper off the drugs. As some have quipped, prescribers have learned to fly the plane but not land it.
20-year Outcomes for First-episode Psychosis: Impact of Neuroleptic Drug Discontinuation
Standard treatment guidelines in psychiatry recommend that neuroleptic drugs are continued indefinitely after a person has experienced more than one psychotic episode. These recommendations are based on studies which have found a higher rate of recurrence of psychosis among those who stop as compared to those who remain on drug.
Anatomy of an Epidemic raised concerns about the long-term outcomes for those who remain on these drugs. Most psychiatrists, including me, assumed that by reducing risk of relapse one would be improving long-term outcome. However, there seems to be reasonable evidence that this assumption is not correct.
Not only does long-term use of drugs expose people to the risks of weight gain and tardive dyskinesia, the drugs may also impair functional outcome. My own view is that this is a discussion psychiatrists need to have with their patients. A person may choose to accept a higher (and not inevitable) risk of recurrence of psychosis as a way to minimize the long-term risks of negative outcomes associated with staying on drug.
Crisis Now: Transforming Services is Within Our Reach
The following is a report from the National Action Alliance for Suicide Prevention Crisis Services Task Force from 2016, which focuses on transforming crisis response services to include recognition and response to trauma, a robust role for peer support, and a reorientation to recovery. This report, which we currently are finding very valuable in our on-going system transformation efforts in Connecticut, is a testament to the fact that even acute services, and even those services addressing persons in extreme distress, can be made strength-based, person-centered, culturally responsive (in including natural and community supports), and recovery-oriented.
Soteria: Reflections on “Being With”, finding one’s way through psychosis
Soteria Housereflections from a former staff member: What is psychosis? Altered states? Extreme states? And why psychiatry is failing to support people during these challenging times.
After 40 years of working in the mental health field, I reflect on the beginning of my career in a National Institute of Mental Health–funded research project called “Soteria House.” I moved on to work in the public sector from crisis worker, to supervisor, to program manager, to Chief of Adult Outpatient services for the public mental health system in Santa Cruz County, California. I have come full circle, back to the lessons learned at Soteria House in the mid-1970s.
It is from this work experience that I learned about “extreme states”, aka persons labeled with psychosis and schizophrenia. As a 23-year-old undergraduate student working on my own major, art therapy, at University of California Santa Cruz, I was offered a field placement assignment at Soteria House.
My background was primarily art, but I was being encouraged to explore a new field called “art therapy.” This brought me to Soteria in San Jose, California. I arrived at Soteria, my first day on the job to find a Victorian-style large home in the heart of San Jose.
What Would a Truly Integrated System of Care Look Like?
Imagine that you were the director of a health insurance company and you had just agreed to provide health coverage to several hundred thousand people and you will have to fund health care including mental health and alcohol/drug care too. This is called “integration.”
What it means financially is that you will lose a lot of money if you ignore the physical health needs of people with mental health problems. In the parlance of insurance folks, you’re “at risk.”
Now, someone walks into your office and tells you that about a quarter to a third of the people you’ve just signed up to serve are being poisoned but no one really knows about it or recognizes it. If it’s true, you stand to lose a lot of money unless you figure out what’s going on. And what if they also tell you that the poisoning is not some form of environmental pollution like smoky air or unclean water but is actually being caused by the very providers of health and mental health that you’re about to be supporting?
Since you’ve been in the health insurance business for a while, you recognize that in western medicine, almost everything that’s provided is some form of mutilation, i.e. surgery, or poisoning, i.e. medications. (Please note that if you’re a physician and reading this and taking some level of offense, the recognition I just pointed to was made by a physician, a well-respected one at that and he meant no offense, nor do I – just a simple way of thinking about things and the key question is whether the risks outweigh the benefits or vice versa.)
Psychiatry likes to portray itself as a scientific discipline, and indeed there is a lot of useful science to draw on when evaluating the evidence base connected to mental health problems, its causes and treatments. Sadly, most of the mainstream psychiatric literature of recent decades has shown a marked preference for rhetoric over scientific accuracy. Research and discourse in psychiatry are now dominated and infected by scientism — the promotion of a belief, sometimes intentionally, sometimes not, that because what you do and talk about sounds and looks like ‘science,’ it is ‘scientific’ — rather than a rational engagement with the nature and consequences of the actual scientific findings.
This scientism has sometimes scared critics from engagement with the actual science in preference of critiquing the suitability of using scientific reasoning to understand what we today define as ‘mental health.’ Opening the lid on both issues (the lack of engagement with the actual scientific findings and the suitability of using particular scientific methods for all knowledge generation) is important. We must endeavour to make transparent the grand deception that organisations such as the one I belong to (the British Royal College of Psychiatrists) are selling to the public about the nature of what we have come to call ‘mental illness,’ its causes, its treatments, and the way we should organise services to help those who become mentally unwell.