In her eighth poem of the series, poet Brenda McDonald describes what it's like to carry the burden of a secret. For many one's secret may be their mental illness, their suicidal thoughts, or their struggles with substance abuse and addiction. As Brenda beautifully alludes to, having such a secret can be immensely painful; however, there is light, hope, and relief when one is able to release this darkness by finding someone who they feel safe to share it with.
Put your knowledge and skills to the test with Mr. L who presents himself to hospital following an intentional overdose with acetaminophen. Upon psychiatric assessment, the patient reports that he is depressed, but his mood and suicidal ideation are directly related to his current financial situation as he is worried he cannot afford food or his medical expenses.
The patient has a history of a developmental disability, and describes a lack of social support, despite nearby family. He tells you that the hospital could help provide him food and requests $600 to alleviate his financial stressors and suicidal thoughts.
He is noted to have been last admitted 3 weeks ago, and has since visited the ER on 2 previous occasions requesting food, money, and residential facility placement.
What is your differential diagnosis? How would you manage this patient's requests?
"Suicidal and asking money for food" by Kuklinski LF, Davis MJ, and Folks DG (Current Psychiatry).
While "Internet/Video Gaming Disorder" is still a controversial diagnosis and is listed as a 'condition requiring further clinical research' in the DSM-5: Diagnostic and Statistical Manual of Mental Disorders, emerging stories such as Cam Adair's, reveal that addictions to internet/video gaming can have powerful negative impacts on one's daily function, relationships, and mental well-being.
So why are video and online games so addictive? As Adair describes in his TEDx talk (link below), games are enticing because they offer a temporary escape from one's problems and they are social and offer interpersonal connections that are based solely on common interests and video game prowess which is enticing especially for many who have been bullied in the past. In addition, these games offer a challenge/sense of meaning or purpose and the chance to feel successful, and they're a source of constant measurable growth, frequently providing rewards for the time and efforts kids put in.
As he describes in both the article and video, by identifying these critical "four pillars of needs", Adair learned what gaming was providing him, and more importantly, what healthier alternatives needed to provide him with in order for him to be successful in curbing his gaming behaviours.
"The proportion of Ontario students with symptoms of a video gaming problem in 2015 was 13 per cent, compared to 9 per cent in 2007, according to a health survey by the Centre for Addiction and Mental Health (CAMH) in Toronto. (It defined symptoms as “preoccupation, tolerance, loss of control, withdrawal, escape, disregard for consequences, disruption to family/school.”)
And boys are four times more likely than females to exhibit problem gaming, CAMH says...
...A number of studies have consistently shown that individuals addicted to gaming show a “comorbidity” — one or more additional conditions — such as ADHD (attention deficit hyperactivity disorder) and MDD (major depression)".
To learn more about Adair and his story, check out these links:
In a powerful essay for Glamour magazine, Chrissy Teigen shares her experience with postpartum depression, following the birth of her daughter Luna.
Postpartum depression is very common as it can affect up to 20% of new mothers. However, as Chrissy eloquently describes, it can be incredibly difficult for one to recognize the disorder amongst themselves, but help is available in the form of additional support, psychotherapy, and medication.
"Before the holidays I went to my GP for a physical. John sat next to me. I looked at my doctor, and my eyes welled up because I was so tired of being in pain. Of sleeping on the couch. Of waking up throughout the night. Of throwing up. Of taking things out on the wrong people. Of not enjoying life. Of not seeing my friends. Of not having the energy to take my baby for a stroll. My doctor pulled out a book and started listing symptoms. And I was like, “Yep, yep, yep.” I got my diagnosis: postpartum depression and anxiety ...
... Before this, I had never, ever—in my whole entire life—had one person say to me: “I have postpartum depression.” Growing up in the nineties, I associated postpartum depression with Susan Smith [a woman now serving life in prison for killing her two sons; her lawyer argued that she suffered from a long history of depression], with people who didn’t like their babies or felt like they had to harm their children. I didn’t have anything remotely close to those feelings. I looked at Luna every day, amazed by her. So I didn’t think I had it.
I also just didn’t think it could happen to me. I have a great life. I have all the help I could need: John, my mother (who lives with us), a nanny. But postpartum does not discriminate. I couldn’t control it. And that’s part of the reason it took me so long to speak up: I felt selfish, icky, and weird saying aloud that I’m struggling. Sometimes I still do."
To read the full story, visit:
Access to care is one of the largest barriers facing individuals with eating disorders. An innovational approach to eating disorder treatment is emerging, however, in response to this issue. Mobile applications have emerged that enable patients with eating disorders to connect with their treatment provider electronically between sessions. Patients can log their food intake/meals as well as thoughts, behaviours, and emotions (and more) throughout the day, which can be viewed by the treatment provider electronically. The application enables users and their respective health care providers to recognize patterns and associations regarding the disordered behaviour.
In addition, patients can communicate with their treatment provider electronically in between formal appointments. Such mobile applications have also offered user’s the ability to access acute crisis support services and chat lines. Mobile access to support may not only help in addressing the issue of access to care, but may be extremely valuable for those who are less comfortable seeking care in-person, those who are geographically isolated from treatment facilities, or those who are less confident in seeking help. It would also provide an opportunity for continued care and support between formal appointment sessions.
Read more here:
In this poem, Anna Lente, poet, artist, and The Mighty contributor, helps us to grasp a little understanding of what it's like for individuals who suffer from multiple mental health disorders such as anxiety and bipolar disorder.
"... Another day Mania spins me in circles,
My mind leaping to dizzying heights,
Spiraling flights of thoughts,
While I use every bit of my inner strength to
Sit and stay,
Waiting for the eventual
Crash back into depression.
Then crawling out from depression
Back to something akin to normal.
Some days loud, crowded spaces trigger panic attacks.
I enter rooms looking for empty corners and exit signs.
I enter conversations listening for pauses so I can escape.
A panic attack means a quick retreat
To the safe space of my car,
The comfort of my home.
I cover myself in blankets
In the comfortable cocoon of my recliner,
Listen to my favorite songs on repeat,
Tell myself everything will be OK..."
To read the full poem, visit:
Put your knowledge and skills to the test with the case of patient A, a 6 year old child, who is brought to your office due to a repetitive self-injurious behaviour in which she repeatedly jams her finger into her nose, leading to multiple nosebleeds per day.
Based on additional history, you determine that these symptoms began at age 3, and are associated with multiple fears (vomiting, storms, public bathrooms, parents' dying), bedtime checking rituals, and involuntary motor and vocal tics such as facial grimacing and throat clearing. She has recurrent UTIs, but is otherwise healthy. There is no history of trauma/abuse. She has been receiving CBT for the last year, and is not on any meds.
What diagnoses are on your differential? What further information would help you distinguish between these diagnoses? What treatment would you suggest?
"A girl repeatedly jabs her finger up her nose: Compulsion or self-injury?" by Butkus M and Vinch J (Current Psychiatry).
Recently, the World Health Organization (WHO) released a report that examined the global health impact of common mental health issues including depression and anxiety. The report provides estimates of the prevalence of such conditions globally, and how these prevalence has changed in the last decade, in addition to the overall consequences on our health and well-being.
Most strikingly, the report demonstrates that over 300 million people worldwide or 4.4% of the global population are affected by depression; an increase of 18% in the last decade. In addition, the WHO has now ranked depression as the leading cause of disability worldwide (leading to 50 million Years Lived With Disability), due to the considerable losses on health and functioning it causes.
Anxiety disorders was also found to affect over 250 million people worldwide or 3.6% of the global population; an increase of 14.9% in the last decade. Anxiety disorders are ranked 6th in terms of contributing to global disability.
"When long-lasting and with moderate or severe intensity, depression may become a serious health condition leading, at its worst, to suicide. According to the report, some 800,000 people kill themselves every year, a significant number of them young adults between the ages of 15 and 29."
For the full report, click here:
For a shorter synopsis of the report, visit:
Many of those who work in the health professions can attest to the stress that comes with the job; the result of a combination of an environment involving sleep deprivation, high demands and responsibility, and pressure-fueled situations that are constantly changing and which we have limited control of. Due to this, physicians and medical trainees are at increased risk of burnout, depression and anxiety, and suicide.
While there is a growing body of evidence that demonstrates the problem of stress among those who work in the healthcare industry, we haven't yet caught up with ways to tackle the problem. However, the Resident Doctors of Canada are implementing a new program that aims to improve physicians' resiliency and in doing so prevent burnout. Interestingly, the initiative is based on a training program utilized by the US Navy Seals and Canadian military to enhance the psychological and emotional strength of their troops.
"The training consists of two key pillars.
Participants are taught to spot where they fall at any given time on a mental health "continuum" or colour-coded stress scale.
Four zones — green, yellow, orange and red — represent escalating levels of stress and dysfunction and include recommended actions that doctors can take to reduce their levels of stress.
The second pillar consists of four skills that can control the body's hormonal response to stress, with the goal of overriding fear.
The skills seek to bypass the brain's amygdala — the emotional response centre that can stimulate a fight-or-flight response — and favour the frontal lobe, where rational decision-making occurs."
To find out more, click here:
Attention those interested in internal medicine, family medicine, cardiology and cardiac surgery! Did you know that there's a link between mental illness and cardiovascular disease?
While not entirely well understood, the link between mental illness and CVD goes both ways. Specifically those with mental illness are at higher risk of heart disease, likely secondary to substance use, unhealthy lifestyle behaviours, and side effects of certain psychotropic medications, as wellas higher rates of mortality and morbidity related to heart disease, perhaps due to noncompliance with medications, and physiologic effects of stress and low mood on the body.
However, those with heart disease are also at higher risk for depression and anxiety. In fact, growing evidence indicates that rates of depression are higher among those with CAD, as well as those who have had a history of MI and/or cardiac revascularization procedures compared to that of the general population.
While new studies are being conducted to examine the use of certain medications, such as SSRIs in treating heart disease and statins for management of depression, our current focus should be on optimizing our patients' well-being and reminding ourselves of the connection between physical and mental health. As such, consider the emotional impact of a new diagnosis of CVD or recommendation of surgery, and consider screening for mental health conditions in patients with known heart disease as addressing both issues is important to a patient's overall function, longevity, and quality of life.
"I’ve chatted with patients about the crippling demands that heart transplants or bypass surgeries place on them. I’ve listened as patients struggle to speak, breathing heavily, lungs filled with fluid from congestive heart failure. Some patients fall into despair after years of endless medications, hospitalizations and poor health. Others are petrified by the operating room and the long road to recovery that lies ahead...
...Depressed patients with cardiac disease have mortality rates twice as high as their non-depressed counterparts. Heart disease patients with depression are at higher risk of cardiac arrest, complications from surgery and hospital readmission after undergoing procedures than those without depression."
To read more, visit:
Supporting and enhancing students' and health professionals' knowledge and understanding of mental health and psychiatry