To learn more about this enlightening research see Dr. Nadine Burke Harris' TED Talk:
We now understand better than ever how exposure to early adversity affects the developing brains and bodies of children. It affects areas like the nucleus accumbens, the pleasure and reward center of the brain that is implicated in substance dependence. It inhibits the prefrontal cortex, which is necessary for impulse control and executive function, a critical area for learning. And on MRI scans, we see measurable differences in the amygdala, the brain's fear response center. So there is concrete neurologic evidence why those exposed to high doses of adversity are more likely to engage in high risk behaviour and suffer worse health outcomes.
To learn more about this enlightening research see Dr. Nadine Burke Harris' TED Talk:
Benzodiazepines are a type of medication which fall under the sedative-hypnotic class, and work by enhancing the activity of the neurotransmitter GABA. While benzos are most well-known for their sedating and anxiolytic effects, they have been used in the treatment of those with seizures, alcohol withdrawal, for anesthesia purposes, as well as for insomnia and mental health issues like anxiety (particularly in the short term).
Interestingly from a historical perspective, benzos were also the original treatment for PTSD, and were thought to be beneficial in treating PTSD symptoms rapidly, particularly anxiety and trouble sleeping. While statistics range from 30% to upwards of 74% of those with PTSD being treated with benzodiazepines of some kind, there is growing evidence that suggests that these medications are not effective in treating the core symptoms of PTSD (i.e. hyperarousal, dissociation, and avoidance).
In addition, studies have also suggested that use of benzodiazepines for those with PTSD may be in fact be harmful with risks that far outweigh the benefits. The studies below suggest that we should be very cautious in prescribing benzos for PTSD due to the high rates of comorbid substance use disorders (a serious risk given the tolerance/withdrawal associated with these meds), in addition to suggestions that benzos may in fact worsen overall severity of PTSD, depression and treatment outcomes for those who are affected.
To learn more, check out these articles:
Don't forget that this week (October 2 - October 8 2016) is Mental Illness Awareness Week, a public education campaign run annually by the Canadian Alliance on Mental Illness and Mental Health.
"This year’s MIAW theme is Spreading Awareness, Reducing Stigma. As one in five Canadians live with mental health issues, the campaign encourages Canadians to share their personal stories about stigma and how it negatively affects them in their personal life, in the workplace, or in their community."
To find out more about this campaign, watch videos from Canadians impacted by mental illness share their stories, and get in on the online conversation you can use #MIAW2016 on Twitter or visit http://www.camimh.ca.
Many of us who work in a hospital environment are familiar with emergency codes including Code Red, Code Blue and even Code White. But does your hospital happen to have a "Code Lavender"? A few hospitals in the US have begun employing this new code as a way to provide urgent care to patients, families, and more especially nurses and physicians who are in need of emotional and/or spiritual support. Physician burn-out, grief, or stress ... now there is a code for that!
At the Cleveland Clinic in Ohio, the Code Lavender Program has been operating for over 8 years, and provides holistic care services for both their patients and employees. In addition, they also have a rapid response team which can provide more intensive and immediate support for those who are struggling with stress, burnout, grief and loss while on the job.
"Within 30 minutes of a call, the Clinic’s team of holistic nurses arrives at the unit in need to provide Reiki and massage, healthy snacks and water, and lavender arm bands to remind the nurse or physician to take it easy for the rest of the day...
The Healing Services Team employs holistic methods that include spiritual support, counseling and therapeutic massage. Bringing together conventional medicine and alternative remedies, the Clinic also offers employees yoga classes, weight loss programs and mindfulness training."
To find out more about this program, click the link below:
If you've heard of the medication gabapentin before, you'll recall that it is most often used in the treatment of seizures as well as neuropathic pain.
However, addiction medicine specialists have been beginning to use the medication in the management of patients with alcohol use disorder, due to growing evidence that gabapentin, when used at moderate-high doses and compared to placebo, increases abstinence rate and days free of heavy drinking. In addition, studies also demonstrate that gabapentin can reduce withdrawal symptoms and aid in long-term recovery by reducing anxiety, insomnia, and cravings.
The most common side effect of the medication is sedation and drowsiness. Doses tend to commonly range from 900-1800mg per day in TID divided dosing, but can be as high as 3600mg a day.
To find out more, check out one of the RCTs that examined the utility of gabapentin for alcohol use disorder:
Alcohol withdrawal is not an uncommon presentation in our healthcare system. From patients making ER visits to get help for withdrawal symptoms to patients with a history of heavy or chronic alcohol use being admitted to medical and surgical units where they experience abrupt cessation of their alcohol consumption, it is important that physicians of all specialties be able to determine an individual's drinking history and risk of alcohol withdrawal, as well as be able to manage the withdrawal syndrome accordingly.
While the CIWA protocol is the tool we are most familiar with in terms of assessing a patient's withdrawal symptoms and guiding treatment with medications, in the last few years a new assessment tool has been developed as a way to help providers distinguish between those who are at risk of developing more "complicated" forms of withdrawal that require more intensive monitoring and management, and which are more highly associated with morbidity, mortality, and healthcare resources.
The tool is known as PAWSS "Prediction of Alcohol Withdrawal Severity Scale", and provides physicians with guidelines of both clinical investigations to order and questions to ask patients, to determine one's risk of experiencing severe withdrawal including seizures and delirium tremens. Based on current literature, it is thought that the scale is both highly sensitive and specific, when a score threshold of 4 is used.
To read more about the PAWSS tool, click here:
#depression redefined in Dr. Kelly Brogan's new novel ' A Mind of Your Own' where she cites lifestyle imbalances and inflammation as potential causes. She urges her patients to see:
'depression as an opportunity, a sign for us to stop and figure out what’s causing our imbalance rather than just masking, suppressing, or rerouting the symptoms. It’s a chance to choose a new story, to engage in radical transformation, to say yes to a different life experience.'
Depression redefined in Dr. Kelly Brogan's new novel ' A Mind of Your Own' where she cites lifestyle imbalances and inflammation as potential causes. She urges her patients to see:
"Depression as an opportunity, a sign for us to stop and figure out what’s causing our imbalance rather than just masking, suppressing, or rerouting the symptoms. It’s a chance to choose a new story, to engage in radical transformation, to say yes to a different life experience."
For more information, check out:
With increasing evidence shedding light on the high rates of burn-out, depression, and suicide among medical students, residents, and new physicians, there has been a new focus on better training our new generation of physicians for dealing with the emotional and psychological strain and stress of medical training.
Recently, an article was published by Macleans, which reviews some of the new resiliency programs being offered to medical students and residents at programs across the country.
To find out more, click here: http://www.macleans.ca/education/new-curriculum-addresses-mental-health-for-young-doctors/
Marine corp veteran and suicide survivor, Timothy Lawson, shares some powerful insights into how we can improve suicide prevention efforts in our communities based on his own experiences as well as his observations from an 18 month study of suicide among the veteran population.
Specifically, Lawson challenges us to adopt a proactive approach to mental health, and one that incorporates 4 simple components: empathy, a sense of purpose, mentorship, and knowledge that we matter.
"If I went to a doctor to show concern about heart disease, he or she would probably recommend nutrition, fitness, and overall care for my cardiovascular system. My doctor would not need to see me at risk for heart disease to recommend these preventative measures. I do not need to show symptoms for my doctor to be proactive about my physical health. Yet the culture around mental health, specifically suicide prevention is reactive. We wait until we see the signs ... then we act. Is the person talking about death often? Are they giving their belongings away? Did they seem distant or detached? I'm here to challenge us all to be proactive about suicidal behaviour and suicide prevention."
Supporting and enhancing students' and health professionals' knowledge and understanding of mental health and psychiatry