Category: Featured news

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Talking about Death May Prevent End-Of-Life Suffering

80Anxiety, Decision-Making, Featured news, Grief, Health, Psychopathy December, 17
Source: Marica Villeneuve, Trauma and Mental Health Report artist, used with permission

Death comes unexpectedly. As City University of New York professor Massimo Pigliuccionce said, “You can evade taxes. But so far, you can’t evade death.” Just what is it, though, that we are trying to evade?

“We don’t know how or when we will die – even as we are actually dying,” wrote Joan Halifax, medical anthropologist and Zen teacher. “Death, in all its aspects, is a mystery.”

But we can talk. In conversation, we are able to clarify our wishes for end-of-life care, express our fear of the unknown, and grieve the loss of a loved one.

The “Death Café”, or “café mortel”, is a movement in which strangers meet to talk about death over tea and cake. The first “café mortel” was hosted in 2004 by Swiss sociologist and anthropologist Bernard Crettaz. In 2011, the movement migrated to the UK and took on the name “Death Café”. Their website states:

“Our aim is to increase awareness of death to help people make the most of their (finite) lives.”

In an article for Aeon magazine, freelance essayist Clare Davies described the kinds of topics explored at Death Café:

“The guests take turns to voice their thoughts and feelings across a wide range of subjects. How does it feel to lose a parent? What is existence? What matters most to us in life? The point is to talk. What is death like? What exactly are we afraid of? To what degree do our ideas on death influence how we live?”

But death isn’t an easy topic… even some doctors avoid it.

A 2015 study led by Vyjeyanthi Periyakoli at the Stanford University School of Medicine found that 86% of 1040 doctors said that they find it “very challenging” to talk to patients about death.

Yet, conversations that explore patient values are essential to end-of-life care. Many prefer to forgo aggressive treatments that are unlikely to prolong life, or improve its quality. Conversations ensure that patients are protected from unwanted treatments and excessive rescue measures that may lead to distress.

End-of-life distress can take many forms. Medications and surgeries often leave the body frail and vulnerable to other illnesses, or dependent on a ventilator or intravenous nutrition.

In a 2010 New Yorker article entitled “Letting Go”, medical doctor and public health researcher Atul Gawande wrote:

“Spending one’s final days in an intensive care unit because of terminal illness is for most people a kind of failure. You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place.”

End-of-life decisions can be stressful for both the patient and doctor. But talking about them does help.

In the New Yorker article, Gawande describes a 2008 Coping with Cancer study in which only one third of patients reported talking with their doctors about goals for end-of-life care, even though they were, on average, four months from death. Those who did have end-of-life conversations were significantly less likely to undergo cardiopulmonary resuscitation, be put on a ventilator, or end up in an intensive care unit. Gawande wrote:

“These patients suffered less, were physically more capable, and were better able, for a longer period, to interact with others. In other words, people who had substantive discussions with their doctor about their end-of-life preferences were far more likely to die at peace and in control of their situation, and to spare their family anguish.”

Audrey Pellicano hosts the New York Death Café, and works as a grief counsellor. She told the New York Times:

“Death and grief are topics avoided at all costs in our society. If we talk about them, maybe we won’t fear them as much.”

This sentiment is echoed by palliative care specialist Susan Block, who was interviewed by Gawande for the New Yorker article. Regarding end-of-life conversations, she said:

“A large part of the task is helping people negotiate the overwhelming anxiety—anxiety about death, anxiety about suffering, anxiety about loved ones, anxiety about finances.”

Fear surrounding life’s end is immense and varied. But death comes regardless. Perhaps what is needed is an ideological shift, supported by movements like the Death Café, which provides opportunities for people to discuss death from a safe distance. By facing death, a greater appreciation of life’s preciousness may emerge, clarifying what we want most from both living and dying.

–Rebecca Abavi, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

ra_feature-1-marica-_-cropped-470x260-1.jpg

Talking About Death May Prevent End-Of-Life Suffering

00Anxiety, Decision-Making, Featured news, Grief, Health, Psychopathy December, 17
Source: Marica Villeneuve, Trauma and Mental Health Report artist, used with permission

Death comes unexpectedly. As City University of New York professor Massimo Pigliuccionce said, “You can evade taxes. But so far, you can’t evade death.” Just what is it, though, that we are trying to evade?

“We don’t know how or when we will die – even as we are actually dying,” wrote Joan Halifax, medical anthropologist and Zen teacher. “Death, in all its aspects, is a mystery.”

But we can talk. In conversation, we are able to clarify our wishes for end-of-life care, express our fear of the unknown, and grieve the loss of a loved one.

The “Death Café”, or “café mortel”, is a movement in which strangers meet to talk about death over tea and cake. The first “café mortel” was hosted in 2004 by Swiss sociologist and anthropologist Bernard Crettaz. In 2011, the movement migrated to the UK and took on the name “Death Café”. Their website states:

“Our aim is to increase awareness of death to help people make the most of their (finite) lives.”

In an article for Aeon, freelance essayist Clare Davies described the kinds of topics explored at Death Café:

“The guests take turns to voice their thoughts and feelings across a wide range of subjects. How does it feel to lose a parent? What is existence? What matters most to us in life? The point is to talk. What is death like? What exactly are we afraid of? To what degree do our ideas on death influence how we live?”

But death isn’t an easy topic… even some doctors avoid it.

A 2015 study led by Vyjeyanthi Periyakoli at the Stanford University School of Medicine found that 86 percent of 1040 doctors said that they find it “very challenging” to talk to patients about death.

Yet, conversations that explore patient values are essential to end-of-life care. Many prefer to forgo aggressive treatments that are unlikely to prolong life, or improve its quality. Conversations ensure that patients are protected from unwanted treatments and excessive rescue measures that may lead to distress.

End-of-life distress can take many forms. Medications and surgeries often leave the body frail and vulnerable to other illnesses, or dependent on a ventilator or intravenous nutrition.

In a 2010 New Yorker article entitled “Letting Go”, medical doctor and public health researcher Atul Gawande wrote:

“Spending one’s final days in an intensive care unit because of terminal illness is for most people a kind of failure. You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place.”

End-of-life decisions can be stressful for both the patient and doctor. But talking about them does help.

In the New Yorker article, Gawande describes a 2008 Coping with Cancer study in which only one-third of patients reported talking with their doctors about goals for end-of-life care, even though they were, on average, four months from death. Those who did have end-of-life conversations were significantly less likely to undergo cardiopulmonary resuscitation, be put on a ventilator, or end up in an intensive care unit. Gawande wrote:

“These patients suffered less, were physically more capable, and were better able, for a longer period, to interact with others. In other words, people who had substantive discussions with their doctor about their end-of-life preferences were far more likely to die at peace and in control of their situation, and to spare their family anguish.”

Audrey Pellicano hosts the New York Death Café, and works as a grief counsellor. She told the New York Times:

“Death and grief are topics avoided at all costs in our society. If we talk about them, maybe we won’t fear them as much.”

This sentiment is echoed by palliative care specialist Susan Block, who was interviewed by Gawande for the New Yorker article. Regarding end-of-life conversations, she said:

“A large part of the task is helping people negotiate the overwhelming anxiety—anxiety about death, anxiety about suffering, anxiety about loved ones, anxiety about finances.”

Fear surrounding life’s end is immense and varied. But death comes regardless. Perhaps what is needed is an ideological shift, supported by movements like the Death Café, which provides opportunities for people to discuss death from a safe distance. By facing death, a greater appreciation of life’s preciousness may emerge, clarifying what we want most from both living and dying.

–Rebecca Abavi, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Medical Marijuana for PTSD?

00Addiction, Featured news, Post-Traumatic Stress Disorder, Stress, Therapy, Trauma December, 17

Source: Sinclair Terrasidius at flickr, Creative Commons

On October 1, 2016, a Canadian medical marijuana company called Marijuana for Trauma opened a location in Edmonton, Alberta to treat PTSD in military veterans. It’s owned and operated by Fabian Henry, who uses marijuana to treat combat-related PTSD, resulting from his second tour of duty in Afghanistan. He claims that conventional medicine does not allow people struggling with PTSD to process their trauma, while marijuana does.

Although the use of medical marijuana for the treatment of physical and psychological disorders is controversial, medical marijuana is currently legal in Canada.

The Washington Post reported that therapeutic use of marijuana was banned in the U.S. in 1970, and marijuana is still categorized as an illicit drug despite its potential medicinal benefits. Given its controversial nature and association with stereotypes, cannabis research for treatment of mental disorders has been limited. But scientific interest is intensifying.

A recent study published in Molecular Psychiatry showed that treatment using particular compounds found in marijuana may benefit those with PTSD, and that “plant-derived cannabinoids [psychoactive chemicals] such as marijuana may possess some benefits in individuals with PTSD by helping relieve haunting nightmares and other symptoms of PTSD.”

Research published on Science Daily also looked at symptom reduction in patients with PTSD. As a result of taking medical marijuana, participants reported a decrease in re-experiencing the trauma, less avoidance of situations that reminded them of the trauma, and a decline in hyper-arousal.

There is also anecdotal evidence. In an interview with the Trauma and Mental Health Report, Dianna Donnelly, a counselor and patient at the Canadian Cannabis Clinics, described her experience:

“I am a patient who legally uses cannabis for depression. The cannabis helps mute or lower my negative chatter, which allows for good thoughts and feelings to arise. One Veteran, a friend of mine, who recently started using marijuana instead of prescription medication for PTSD, said that with the cannabis, he can feel his emotions, and experience them properly and safely. Before, he just felt numb.”

Medical marijuana is not usually used on its own for the treatment of PTSD. Shelley Franklin, the Veteran Program Coordinator for the Canadian Cannabis Clinics, explained:

“Medical cannabis is used in conjunction with other therapies. Peer support groups are a highly supported therapy for patients suffering an Operational Stress Injury [another term for PTSD]. Medical cannabis strains with the right CBD and THC [psychoactive chemicals in cannabis] levels are assisting veterans with chronic physical pain, as well anxiety and insomnia issues. I believe that medical cannabis will continue to work in conjunction with many other therapies.”

Conversely, former Canadian Member of Parliament Peter Stoffer believes that soldiers have too much access to medical marijuana. Although not opposed to the use of medical marijuana in certain cases, Stoffer believes that current legislation, which compensates veterans for up to 10 grams of cannabis per day, promotes overuse and could potentially lead to negative effects. In an interview with the CBC, Stoffer said:

“Ten grams a day is an awful lot of marijuana to give one person. It is an incredible amount. That’s simply not the way to go. You’re not helping that person at all. You’re not giving them any chance of recovery. All you’re really doing is masking the pain that they’re suffering.”

The research is still in its infancy and likely to explode in the near future, as the Canadian government prepares to remove restrictions on marijuana in 2017. This movement will make it much easier for researchers to study the effects cannabis has on psychological disorders and to form conclusions on its efficacy.

As for Fabian Henry and his cannabis dispensary Marijuana for Trauma, he continues to work with physicians to tailor the amounts dispensed to individuals and has no plans himself to stop using the drug.

This article was originally published on Psychology Today

an-_-article-2-_-feature-1-_-cropped-470x260.jpg

Medical Marijuana for PTSD?

80Addiction, Featured news, Post-Traumatic Stress Disorder, Stress, Therapy, Trauma December, 17

Source: Sinclair Terrasidius at flickr, Creative Commons

On October 1st, 2016, a Canadian medical marijuana company called Marijuana for Trauma opened a location in Edmonton, Alberta to treat PTSD in military veterans. It’s owned and operated by Fabian Henry, who uses marijuana to treat combat-related PTSD, resulting from his second tour of duty in Afghanistan. He claims that conventional medicine does not allow people struggling with PTSD to process their trauma, while marijuana does.

Although the use of medical marijuana for the treatment of physical and psychological disorders is controversial, medical marijuana is currently legal in Canada.

The Washington Post reports that therapeutic use of marijuana was banned in the U.S. in 1970, and marijuana is still categorized as an illicit drug despite its potential medicinal benefits. Given its controversial nature and association with stereotypes, cannabis research for treatment of mental disorders has been limited. But scientific interest is intensifying.

A recent study published in Molecular Psychiatry showed that treatment using particular compounds found in marijuana may benefit those with PTSD, and that “…plant-derived cannabinoids [psychoactive chemicals] such as marijuana may possess some benefits in individuals with PTSD by helping relieve haunting nightmares and other symptoms of PTSD.”

Research published in Science Daily also looked at symptom reduction in patients with PTSD. As a result of taking medical marijuana, participants reported a decrease in re-experiencing the trauma, less avoidance of situations that reminded them of the trauma, and a decline in hyper-arousal.

There is also anecdotal evidence. In an interview with the Trauma and Mental Health Report, Dianna Donnelly, a counselor and patient at the Canadian Cannabis Clinics, described her experience:

“I am a patient who legally uses cannabis for depression. The cannabis helps mute or lower my negative chatter, which allows for good thoughts and feelings to arise. One Veteran, a friend of mine, who recently started using marijuana instead of prescription medication for PTSD, said that with the cannabis, he can feel his emotions, and experience them properly and safely. Before, he just felt numb.”

Medical marijuana is not usually used on its own for the treatment of PTSD. Shelley Franklin, the Veteran Program Coordinator for the Canadian Cannabis Clinics, explained that:

“Medical cannabis is used in conjunction with other therapies. Peer support groups are a highly supported therapy for patients suffering an Operational Stress Injury [another term for PTSD]. Medical cannabis strains with the right CBD and THC [psychoactive chemicals in cannabis] levels are assisting veterans with chronic physical pain, as well anxiety and insomnia issues. I believe that medical cannabis will continue to work in conjunction with many other therapies.”

Conversely, former Canadian Member of Parliament Peter Stoffer believes that soldiers have too much access to medical marijuana. Although not opposed to the use of medical marijuana in certain cases, Stoffer believes that current legislation, which compensates veterans for up to 10 grams of cannabis per day, promotes overuse and could potentially lead to negative effects. In an interview with the CBC, Stoffer said:

“Ten grams a day is an awful lot of marijuana to give one person. It is an incredible amount. That’s simply not the way to go. You’re not helping that person at all. You’re not giving them any chance of recovery. All you’re really doing is masking the pain that they’re suffering.”

The research is still in its infancy and likely to explode in the near future, as the Canadian government prepares to remove restrictions on marijuana in 2017. This movement will make it much easier for researchers to study the effects cannabis has on psychological disorders and to form conclusions on its efficacy.

As for Fabian Henry and his cannabis dispensary Marijuana for Trauma, he continues to work with physicians to tailor the amounts dispensed to individuals and has no plans himself to stop using the drug.

–Andrei Nistor, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. Muller, The Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Climate Change Affecting Farmers' Mental Health

00Depression, Environment, Featured news, Health, Suicide, Work December, 17

Source: CIAT at flickr, Creative Commons

The cutoff for irreversible climate change has long been accepted as two or more degrees in global temperature compared to pre-industrial records. Reports show that, in early March 2016, this cutoff was crossed for the first time in recorded history.

January and February of 2016 broke all previous monthly records for high temperatures. Accompanying this trend are regular reports of melting ice caps and changes to animal migratory patterns. But the link between climate change and mental health is less visible.

One effect has been observed in farmers who are closely connected to the land. For some, environmental problems stem from an insufficient water supply. For others, too much rainfall is a detriment to crop growth. Not surprisingly, farmers are anxious.

Matthew Russell is an Iowan farmer whose family has tended to their land for five generations. In an interview with Medical Daily, he recounts the physical and psychological toll brought on by extreme climate conditions:

“Psychologically, in the last few years, there’s a lot of anxiety that I don’t remember having 10 years ago. In the last three or four years, there’s this tremendous anxiety around the weather because windows of time for quality crop growth are very narrow.”

Russell explains that this narrow window is due to increasing levels of rain, which leave his land muddy and wet, decreasing crop quality.

Aside from droughts and flooding, extreme temperatures compound the problem, as do weeds, pests, and fungi that thrive better as a result of warmer temperatures and increased carbon dioxide levels.

For those like Russell who have farmed throughout their lives, the idea of uprooting and relocating or finding a new profession seems daunting. With the continuing effects of climate change, this threat may soon become reality.

Anxiety is not the only mental-health concern influenced by climate change. A report from the US National Library of Medicine states:

“An association has been found between crop failures due to unexpected droughts and suicide attempts by the farmers. Failure of a crop can lead to economic hardships. When dependent on low precipitation situations, the farmer might not be able to sustain the expenses of the family and may become a victim of the debt trap to meet the expenses.”

Although the report focuses on droughts in Australian and Indian populations, these experiences are echoed elsewhere, like in California. Drought there has contributed to failed crops for farmers, as well as increased food prices for consumers in North America. A 2012 report showed that the economic hardship associated with these problems has increased the risk of suicide in American farmers.

A study on suicide by Ryan Sturgeon at the University of Calgary examined the content of calls to a rural stress line from farmers in Manitoba, Canada. He found that farmers may not be using the mental health resources open to them:

“Multiple factors may negatively impact farmers’ help-seeking behavior, including greater isolation due to a growing distance between farms, increased competition, and less cooperation among farmers because of the changing global economy, and fragmentation of existing rural communities as more people are moving off farms and into urban areas.”

Problems brought on by climate change are exacerbated in vulnerable rural communities populated by farmers. But as a worldwide phenomenon, climate change is likely to affect mental health globally.

–Andrei Nistor, Contributing Writer, The Trauma and Mental Health Report. 

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

This article was originally published on Psychology Today

an5_feature-1-470x260.jpg

Climate Change Affecting Farmer’s Mental Health

60Depression, Environment, Featured news, Health, Suicide, Work December, 17

Source: CIAT at flickr, Creative Commons

The cutoff for irreversible climate change has long been accepted as two or more degrees in global temperature compared to pre-industrial records. Reports show that, in early March 2016, this cutoff was crossed for the first time in recorded history.

January and February of 2016 broke all previous monthly records for high temperatures. Accompanying this trend are regular reports of melting ice caps and changes to animal migratory patterns. But the link between climate change and mental health is less visible.

One effect has been observed in farmers who are closely connected to the land. For some, environmental problems stem from insufficient water supply. For others, too much rainfall is a detriment to crop growth. Not surprisingly, farmers are anxious.

Matthew Russell is an Iowan farmer whose family has tended to their land for five generations. In an interview with Medical Daily, he recounts the physical and psychological toll brought on by extreme climate conditions:

“Psychologically, in the last few years, there’s a lot of anxiety that I don’t remember having 10 years ago. In the last three or four years, there’s this tremendous anxiety around the weather because windows of time for quality crop growth are very narrow.”

Russell explains that this narrow window is due to increasing levels of rain, which leave his land muddy and wet, decreasing crop quality.

Aside from droughts and flooding, extreme temperatures compound the problem, as do weeds, pests, and fungi that thrive better as a result of warmer temperatures and increased carbon dioxide levels.

For those like Russell who have farmed throughout their lives, the idea of uprooting and relocating or finding a new profession seems daunting. With the continuing effects of climate change, this threat may soon become reality.

Anxiety is not the only mental-health concern influenced by climate change. A reportfrom the US National Library of Medicine states:

“An association has been found between crop failures due to unexpected droughts and suicide attempts in the farmers. Failure of crop can lead to economic hardships. When dependent on low precipitation situations, the farmer might not be able to sustain the expenses of the family and may become a victim of the debt trap to meet the expenses.”

Although the report focuses on droughts in Australian and Indian populations, these experiences are echoed elsewhere, like in California. Drought there has contributed to failed crops for farmers, as well as increased food prices for consumers in North America. A 2012 report showed that the economic hardship associated with these problems has increased the risk of suicide in American farmers.

A study on suicide by Ryan Sturgeon at the University of Calgary examined the content of calls to a rural stress line from farmers in Manitoba, Canada. He found that farmers may not be using the mental health resources open to them:

“Multiple factors may negatively impact farmers’ help-seeking behaviour, including greater isolation due to a growing distance between farms, increased competition and less cooperation among farmers because of the changing global economy, and fragmentation of existing rural communities as more people are moving off farms and into urban areas.”

Problems brought on by climate change are exacerbated in vulnerable rural communities populated by farmers. But as a worldwide phenomenon, climate change is likely to affect mental health globally.

–Andrei Nistor, Contributing Writer, The Trauma and Mental Health Report. 

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Pregnant Women Struggle with Managing Psychiatric Medication

00Anxiety, Featured news, Health, Pregnancy, Psychiatry, Psychopharmacology, Suicide November, 17

Source: Lauren Fritts at flickr, Creative Commons

It is often portrayed as a happy and exciting time but the experience of pregnancy can be mixed, with physical and mental complications dampening the experience.

In a recently released documentary, Moms and Meds, director Dina Fiasconaro addresses the challenges that she and other women with psychiatric disorders face during pregnancy.

Fiasconaro’s goal in making the documentary was to investigate women’s experiences with psychotropic drugs at this life stage. She became pregnant while on anti-anxiety medication and had difficulty obtaining clear information from healthcare professionals.

In an interview with the Trauma and Mental Health Report, Fiasconaro explained:

“I received very conflicting information on what medications were safe from my psychiatrist, therapist, and high-risk obstetrician. Even with non-psychiatric medication, I couldn’t get a clear answer, or from the pharmaceutical companies that manufactured them. No one wanted to say ‘that’s okay’ and be liable if something were to go awry.”

When she spoke to her maternal/fetal specialist, she was provided with a stack of research abstracts regarding the use of certain psychotropic medications during pregnancy. Although the information was helpful, it didn’t adequately inform her about the risks and benefits of medication use versus non-use.

One of the main questions Fiasconaro had was, should she continue using medication and risk harming her baby, or should she discontinue use and risk harming herself?

One of the women featured in Moms and Meds, Kelly Ford, contemplated suicide several times during pregnancy. When her feelings began to intensify, she admitted herself to a hospital. There, she was steered away from taking medication which led her to feel significant distress and an inability to cope with her declining mental health.

Elizabeth Fitelson, director of the Women’s Program at Columbia University, also featured in the documentary, believes there is a tendency for healthcare professionals to dismiss mental illness in pregnant women.

In the film, Fitelson said:

“If a pregnant woman falls and breaks her leg, for example, we don’t say, ‘Oh, we can’t give you anything for pain because there may be some potential risk for the baby.’ We say, ‘Of course we have to treat your pain. That’s excruciating. We’ll give you this. There are some risks, but the risks are low and, of course, we have to treat the pain. ‘”

This lack of validation for mental health issues was echoed by Fiasconaro when she visited her doctor:

“I was referred to a high-risk obstetrician by my therapist. Although I was given the proper advice, that high-risk doctor ended up being very insensitive to my mental illness. She told me that everybody’s anxious and brushed it off like it was a non-issue. I understand that in the larger context of what she does and who she treats, my anxiety probably seemed like a low priority in the face of other, seemingly more threatening, physical illnesses.”

The ambiguous information provided by health professionals is representative of a lack of research on the risks of using medication during pregnancy.

Mary Blehar and colleagues, at the National Institutes of Health (NIH), state in the Journal of Women and Health that data are lacking on the subject. In a review of clinical research on pregnant women, they found that data obtained over the last 30 years, about which medications are harmful and which can be used safely, are incomplete. These gaps are largely due to the majority of information being based on case reports of congenital abnormalities, which are rare and difficult to follow.

During her pregnancy, Fiasconaro was able to slowly stop taking her anxiety medication. But halting treatment is sometimes not an option for women who suffer from severe, debilitating psychiatric conditions such as bipolar disorder, major depression, or schizophrenia.

We also need to improve access to information on pharmacological and non-pharmacological treatment options, including psychotherapy for women with mental-health problems during pregnancy. Without adequate guidance, the management of psychiatric conditions can leave many feeling alone and overburdened. These women often feel stigmatized and neglected by healthcare professionals. The development of supportive and informative relationships is necessary to their wellbeing.

As Fiasconaro put it:

“I had to be pretty focused and tenacious in finding information and then making the most informed decision for myself. I’m grateful I was able to do so, but again, I know every woman might not be in that position, and it can be very scary and confusing.”

–Nonna Khakpour, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

feature-1-470x260_0.jpg

Pregnant Women Struggle with Managing Psychiatric Medication

60Anxiety, Featured news, Health, Pregnancy, Psychiatry, Psychopharmacology, Suicide November, 17

Source: Lauren Fritts at flickr, Creative Commons

It is often portrayed as a happy and exciting time but the experience of pregnancy can be mixed, with physical and mental complications dampening the experience.

In a recently released documentary, Moms and Meds, director Dina Fiasconaro addresses the challenges that she and other women with psychiatric disorders face during pregnancy.

Fiasconaro’s goal in making the documentary was to investigate women’s experiences with psychotropic drugs at this life stage. She became pregnant while on anti-anxiety medication and had difficulty obtaining clear information from healthcare professionals.

In an interview with the Trauma and Mental Health Report, Fiasconaro explained:

“I received very conflicting information on what medications were safe from my psychiatrist, therapist, and high-risk obstetrician. Even with non-psychiatric medication, I couldn’t get a clear answer, or from the pharmaceutical companies that manufactured them. No one wanted to say ‘that’s okay’ and be liable if something were to go awry.”

When she spoke to her maternal/fetal specialist, she was provided with a stack of research abstracts regarding the use of certain psychotropic medications during pregnancy. Although the information was helpful, it didn’t adequately inform her about the risks and benefits of medication use versus non-use.

One of the main questions Fiasconaro had was, should she continue using medication and risk harming her baby, or should she discontinue use and risk harming herself?

One of the women featured in Moms and Meds, Kelly Ford, contemplated suicide several times during pregnancy. When her feelings began to intensify, she admitted herself to a hospital. There, she was steered away from taking medication which led her to feel significant distress and an inability to cope with her declining mental health.

Elizabeth Fitelson, director of the Women’s Program at Columbia University, also featured in the documentary, believes there is a tendency for healthcare professionals to dismiss mental illness in pregnant women.

In the film, Fitelson said:

“If a pregnant woman falls and breaks her leg, for example, we don’t say, ‘Oh, we can’t give you anything for pain because there may be some potential risk for the baby.’ We say, ‘Of course we have to treat your pain. That’s excruciating. We’ll give you this. There are some risks, but the risks are low and, of course, we have to treat the pain. ‘”

This lack of validation for mental health issues was echoed by Fiasconaro when she visited her doctor:

“I was referred to a high-risk obstetrician by my therapist. Although I was given the proper advice, that high-risk doctor ended up being very insensitive to my mental illness. She told me that everybody’s anxious and brushed it off like it was a non-issue. I understand that in the larger context of what she does and who she treats, my anxiety probably seemed like a low priority in the face of other, seemingly more threatening, physical illnesses.”

The ambiguous information provided by health professionals is representative of a lack of research on the risks of using medication during pregnancy.

Mary Blehar and colleagues, at the National Institutes of Health (NIH), state in the Journal of Women and Health that data are lacking on the subject. In a review of clinical research on pregnant women, they found that data obtained over the last 30 years, about which medications are harmful and which can be used safely, are incomplete. These gaps are largely due to the majority of information being based on case reports of congenital abnormalities, which are rare and difficult to follow.

During her pregnancy, Fiasconaro was able to slowly stop taking her anxiety medication. But halting treatment is sometimes not an option for women who suffer from severe, debilitating psychiatric conditions such as bipolar disorder, major depression, or schizophrenia.

We also need to improve access to information on pharmacological and non-pharmacological treatment options, including psychotherapy for women with mental-health problems during pregnancy. Without adequate guidance, the management of psychiatric conditions can leave many feeling alone and overburdened. These women often feel stigmatized and neglected by healthcare professionals. The development of supportive and informative relationships is necessary to their wellbeing.

As Fiasconaro put it:

“I had to be pretty focused and tenacious in finding information and then making the most informed decision for myself. I’m grateful I was able to do so, but again, I know every woman might not be in that position, and it can be very scary and confusing.”

–Nonna Khakpour, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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In Long-Term Care, Patient-on-Patient Violence on the Rise

00Aging, Anger, Cognition, Dementia, Featured news, Health, Trauma November, 17

Source: SpaceShoe at flickr, Creative Commons

A January 2016 Vancouver Sun article reported on 16 seniors in British Columbia (BC) killed in the last 4 years from violence in long-term care facilities.

While the mention of violence in nursing homes conjures images of support workers abusing patients, these altercations actually took place between patients. In each case, either one or both of the people involved suffered from a severe cognitive disability.

In one case, Karl Otessen, who suffered from dementia, had experienced multiple outbursts in which he would attack staff or rip off his clothes. He was on medication, and behavioral strategies had been implemented by the nurses, yet Otessen’s final attack resulted in a fractured hip, and he later died from related complications.

This sort of violence by a patient is rarely premeditated, making it difficult to prevent. The Alzheimer’s Society describes dementia patients as having difficulty describing their needs, leading to frustration and aggression. And dementia often causes decreased inhibition, resulting in violent and unpredictable outbursts.

In an interview with Global News, Sara Kaur, a support worker at a long-term care center in Mississauga, said that “Conflict can be prevented by understanding dementia and a senior’s inability to communicate simple needs.” By understanding the causes and symptoms of a mental-health disorder, a long-term care facility employee has a better chance of resolving potentially violent situations in a productive manner.

Many facilities have reported that they are under-staffed and under-equipped. But an article from Healthy Debate Canada, a publication focusing on the Canadian health care system, notes that:

“While we need more staff in long term care, just establishing an arbitrary number for staffing ratio isn’t the solution; it’s equally important to look at how much time staff are able to spend directly with residents, and whether they have the training they need to provide quality care.”

In Otessen’s case, although nurses tried to use a number of behavioural techniques to calm him, if a specific mental-health treatment plan had been in place, it’s possible that his violent behavior would have been reduced or eliminated entirely.

The Ontario Long Term Care Association, which examines progressive practices for long-term care homes, has suggested the use of specialized teams of nurses and support workers who are trained in identifying the triggers that lead to aggression in dementia patients. After identifying those triggers, the goal is to then create a solution to address the issue and protect other patients.

Using specialized teams may reduce the burden on regular support workers while also addressing the mental health needs of patients in an individualized manner. It is not enough to issue facility-wide policy changes to address behavioural issues when their causes vary from case to case.

The issue of patient-on-patient violence won’t be resolved without further attention. In Canada alone, there are currently over 750,000 individuals living with dementia, a number projected to double in 15 years. The growing elderly population must be considered when implementing budgetary and training changes to long-term care facilities.

–Andrei Nistor, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. Muller, The Trauma and Mental Health Report.

Copyright Robert T. Muller.
 

This article was originally published on Psychology Today

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In Long-Term Care, Patient-on-Patient Violence on the Rise

00Aging, Anger, Cognition, Dementia, Featured news, Health, Trauma November, 17

A January 2016 Vancouver Sun article reported on 16 seniors in British Columbia (BC) killed in the last 4 years from violence in long-term care facilities.

While the mention of violence in nursing homes conjures images of support workers abusing patients, these altercations actually took place between patients. In each case, either one or both of the people involved suffered from a severe cognitive disability.

In one case, Karl Otessen, who suffered from dementia, had experienced multiple outbursts in which he would attack staff or rip off his clothes. He was on medication, and behavioral strategies had been implemented by the nurses, yet Otessen’s final attack resulted in a fractured hip, and he later died from related complications.

This sort of violence by a patient is rarely premeditated, making it difficult to prevent. The Alzheimer’s Society describes dementia patients as having difficulty describing their needs, leading to frustration and aggression. And dementia often causes decreased inhibition, resulting in violent and unpredictable outbursts.

In an interview with Global News, Sara Kaur, a support worker at a long-term care center in Mississauga, said that “Conflict can be prevented by understanding dementia and a senior’s inability to communicate simple needs.” By understanding the causes and symptoms of a mental-health disorder, a long-term care facility employee has a better chance of resolving potentially violent situations in a productive manner.

Many facilities have reported that they are under-staffed and under-equipped. But an article from Healthy Debate Canada, a publication focusing on the Canadian health care system, notes that:

“While we need more staff in long term care, just establishing an arbitrary number for staffing ratio isn’t the solution; it’s equally important to look at how much time staff are able to spend directly with residents, and whether they have the training they need to provide quality care.”

In Otessen’s case, although nurses tried to use a number of behavioural techniques to calm him, if a specific mental-health treatment plan had been in place, it’s possible that his violent behavior would have been reduced or eliminated entirely.

The Ontario Long Term Care Association, which examines progressive practices for long-term care homes, has suggested the use of specialized teams of nurses and support workers who are trained in identifying the triggers that lead to aggression in dementia patients. After identifying those triggers, the goal is to then create a solution to address the issue and protect other patients.

Using specialized teams may reduce the burden on regular support workers while also addressing the mental health needs of patients in an individualized manner. It is not enough to issue facility-wide policy changes to address behavioural issues when their causes vary from case to case.

The issue of patient-on-patient violence won’t be resolved without further attention. In Canada alone, there are currently over 750,000 individuals living with dementia, a number projected to double in 15 years. The growing elderly population must be considered when implementing budgetary and training changes to long-term care facilities.

–Andrei Nistor, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. Muller, The Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today