Put your knowledge and skills to the test with the case of Mr. C, a 61 year old man, who presents to clinic for follow-up on his antipsychotic medications that are used to manage psychosis and depression. He currently uses chlorpromazine 100mg/day and has had no psychotic symptoms in the last 3 years.

In terms of his psychiatric history, Mr. C first began to experience auditory and visual hallucinations at age 48, as well as a decline in cognition that led to his retirement from employment shortly thereafter. He has had 3 inpatient psychiatric admissions, and has continued to be treated with antipsychotics as discontinuation often leads to relapse of his psychosis.

While Mr. C has a history of aortic regurgitation, CHF, HTN, and sensorineural hearing loss, he also describes a history of cocaine abuse from 21-45. More interestingly, he also reveals a diagnosis of syphilis at 48yo, which went untreated for many months until he was diagnosed with neurosyphilis (tertiary syphilis) after developing abnormal gait, blurred vision, and general weakness.

Do you think Mr. C's psychiatric symptoms are related to his diagnosis of neurosyphilis? What tests would you order? What would you advise him on further management/treatment?

​"Psychosis in Treated Neurosyphilis: Is Now The Time To Stop His Antipsychotic?" by Kamalika Roy, Richard Balon, and Varma Penumetcha.

In light of the recent Rio 2016 Olympic Games, former members of the US Womens' Swim Team are speaking out about the prevalence of disordered eating and body image issues among female athletics. More specifically, they speak to competitive swimming, where often individuals push themselves to extremes and experience gruelling training in their quest for top performance, meanwhile they spend almost every day in a bathing suit and develop a muscular built physique which may not be in line with a young woman's views of what femininity and beauty should look like. 

"“Binging and purging was my, I guess, outlet,” said Hyman, 37. “Part of it was my own insecurities; part of it was my own control, the sense of being in control or something I could control. It wasn’t strictly just a body image issue or strictly just, ‘I’m trying to perform better.’ As an athlete I think there were other emotional challenges that I manifested into my eating disorder as a way of coping. It wasn’t something that I was necessarily secretive about. My coaches were aware, my parents were aware, and I wasn’t shy about it. One of the things I’d always prided myself on was discipline...
​
Jennifer Carter, Ohio State University Sports Medicine Center’s director of sport psychology, agrees there are specific risk factors for eating disorders in female athletes, such as a belief that thinness equates to better performance (whereas in male athletes more muscularity equates to better performance), revealing uniforms and, sometimes, a type of perfectionist personality."

For the full article, click here: http://www.usatoday.com/story/sports/olympics/rio-2016/2016/08/03/us-womens-swim-team-body-image-eating-disorders-and-supporting-each-other/88048534/

In this must read article for all current and soon-to-be residents, Dr. Elisabeth Poorman describes her own experience of developing depression while starting work as a new physician. She also highlights other studies, including her own survey of other physicians, to further demonstrate how mental health struggles are not uncommon among those in the medical profession, and despite residency programs and hospitals giving increased attention to "physician wellness and self-care", there are still multiple barriers to finding and receiving adequate support.

At the end of the article, Dr. Poorman also provides some excellent suggestions that may work to better equip new physicians with the help and services they need to address their mental health issues, in addition to helping them build resiliency, one of the biggest keys of all.

"By the end of my first year of residency, I knew I was in trouble.

I was overwhelmed by the 15-hour days, the unbearable sadness of the tragedies I witnessed, my feelings of impotence and my fears of making a mistake.

My life was my work and everything else seemed to be falling apart: my physical health, my relationships, my ability to sleep after months of night shifts.

Yet, I came to work every day. I completed every task. And then I'd go home each night and cry. An administrator pulled me aside one morning: “How’s it going?” she asked.

I began to sob. “Well, get yourself together and get ready for the day,” she said. I dried my tears off in the bathroom and readied for the rest of my 12-hour shift...

... In writing this piece, I've come to realize that we continue to treat mental health disorders in medical training and practice as the exception. But in reality, mental health disorders in residency are the rule, and those who never experience them are the exception. And though it is common, it should not be dismissed as “normal.” We should not tell trainees, as I was told by numerous colleagues and my own providers, that “this is just residency.” I had clinical depression, and it was very treatable once I was able to get adequate care." 

For the full article, click here:
http://www.wbur.org/commonhealth/2016/08/19/depression-resident-doctor?utm_campaign=npr&utm_content=20160821&utm_medium=social&utm_source=facebook.com&utm_term=nprnews

Could Instagram be used to help monitor one's mental health or in screening for depression? A recent study suggests this may just be in our future ...

The study, conducted by researchers at Harvard University and the University of Vermont, analyzed over 43,000 photos posted on Instagram by 166 volunteers. The volunteers were also asked to complete surveys that looked at their social media use, as well as history of mood disorder diagnoses and symptoms of depression.

The results indicated that certain features, such as colour, brightness, and number of faces, of one's online photos may be possible markers for or indicators of depression.

"Those who were depressed tended to post photos with increased hue, decreased brightness, and decreased color saturation. Overall, their photos were “bluer, grayer, and darker.” They also tended to post more frequently and use more Instagram filters, the most popular one for depressed participants being Inkwell, which turns a photo black and white. The most popular filter for volunteers who weren’t depressed was Valencia."
​
To learn more about the study, click here:
https://arxiv.org/ftp/arxiv/papers/1608/1608.03282.pdf
http://fortune.com/2016/08/22/instagram-diagnose-depression/

Since 1973 the American Psychiatric Association have abided by the "Goldwater Rule", which states that it is unethical for psychiatrists to diagnose or offer a professional comment on a public figure's mental status when they have not personally evaluated the individual. The rule was created following the 1964 presidential election in which a magazine had published a survey in which thousands of psychiatrists commented on wether candidate Senator Barry Goldwater was psychologically fit for presidency. 

With the US election in full force and many individuals commenting on the presidential candidates, most notably Donald Trump, again the APA has reminded its members to keep the Goldwater Rule in mind. However, this year some psychiatrists and mental health experts are challenging the Goldwater Rule; some say its for the better good of the nation, while others report that having such in-depth access to candidates nowadays they have greater and stronger information with which to base their opinions on.

"Supporters of the Goldwater Rule have cited three main rationales for adhering to it: Most diagnoses made from a distance turn out to be wrong; the labels themselves can cause real harm to the person and family members; and the practice undermines the field’s credibility, particularly its commitment to confidentiality. Not to mention, others say, that it could expose a left-leaning bias in the field...

But those using clinical language to describe Mr. Trump’s behavior contend that this presidential election is vastly different, for a big reason: The proliferation of social media comments and video clips, which afford direct, unscripted access to candidates, was simply not available in previous races. The depth of that material creates a public persona complete enough to analyze on its own merits, they say."

What are your thoughts on the Goldwater Rule? How do you think mental health professionals should respond when asked their opinions on public figures or presidential candidates mental health?

For the full article, click here:
http://www.nytimes.com/2016/08/16/health/analyzing-donald-trump-psychology.html?emc=eta1&_r=1

In her seventh poem of the series, poet Brenda McDonald describes how for a long time she struggled with a sense of failure at not being strong enough or working hard enough to overcome mental illness. However, Brenda later discovered that by eliminating the pressure on oneself and removing "should" from your vocabulary, she was able to focus more on self-care and self-love which was monumental in her recovery.

BE TRUE
I should
And I would if I could
But I can't or can I
Guilt for won't instead of will
Try harder why don't you
Success for do instead of me
Am I not enough
Right now or not yet
Till I change
I should
And I would if I could...

What if I got rid of should
I'm okay, me right now
Let go of would and could
Free myself from guilt
Embrace the 'I am' today
Release the weight of 'I do'
Be open to my strengths
Feel my heart cheer me on
See the beauty of my mind
Listen to my soul's nudges
To choose, I'll try, for me, be true.

Feeling like practicing some of your mental status examination skills? While it may seem simple to ask patients about their mood, comparing one's stated mood to their affect in terms of congruency and generating a description of their affect can be quite challenging, but is a key skill in psychiatry.
​
In this video, we see examples to help us navigate between different descriptions of affect and mood including euthymia, dysphoria, elated/euphoria, lability, as well as better understand the range of affect from full to blunted and flat.

After losing his brother-in-law at the age of 23 to suicide, UK rugby league player Luke Ambler took it upon himself to raise awareness for mens mental health. Most notably, Luke has created a club called "Andy's Man Club" where men can come together to chat about their lives and well-being. On top of that, Luke's also started a new social media campaign to spread the message further, where individuals are nominated by friends online to post a picture of themselves giving the the "okay" gesture and with the hashtag #itsoktotalk. 

"He said: “Without any warning Andrew was taken away from all his family and friends by suicide. What is staggering is that 42 per cent of men aged 18 to 45 have considered suicide as an option. 

“Then add to that, the single biggest killer of men under 45 is suicide. Around 4200 men, that’s one man every two hours, a year are taken from this world and their families by suicide, it is quite unbelievable that there isn’t that much awareness. 

“What seems to be a big underlying problem for men is their inability to speak out about what is bothering them.”"

For more about the campaign click here:
http://www.itv.com/news/calendar/2016-08-11/itsoktotalk-rugby-player-launches-male-mental-health-campaign/
http://video.bestthenews.com/video/itsoktotalk-brilliant-new-way-raising-awareness-male-suicide-get-involved-fri-08052016-2256

Having experienced depression and anxiety firsthand, and living in a community in South Africa called Lebowakgomo, where mental illness is rarely discussed and more often ignored or misdiagnosed, photographer Tsuko Maela used his craft to help others suffering from mental health conditions. 

His series, "Abstract Peaces", acts like a visual diary, chronicling "a person who was trying to breath during a very difficult time, trying to find themselves, trying to make sense of their struggle. And what they found was peace." Through his art, Maela hopes to help advocate for mental health, especially among the black communities in both South Africa and around the world. The biggest message Maela works depict is that there is no shame in mental illness, rather there is an opportunity to break the silence by sharing stories of experience, recovery, and hope.

""Growing up in a black community you quickly learn that there is a list of problems that do not ‘affect’ black people:
Mentally ill? Bewitched, or you simply study too hard.

Depressed? Lighten up, you’ve been watching way too many of those white teen movies.

Seeing a psychologist? You’re weak and should probably stop that before the neighbours find out.""

To check out this story and Maela's works of art click here:
http://10and5.com/…/using-photography-to-destigmatise-ment…/
http://abstractpeaces.tumblr.com

A resident speaks up about how her hospital and residency program handled physician wellness and building ‪‎resiliency‬ after the third internal medicine resident died by ‪suicide‬. She also offers suggestions on how our healthcare system should really be supporting their learners. A powerful ‪‎must read‬ for all ‪‎med students‬ and residents alike ...

"At that noon conference, we found out that one of our fellow residents had committed suicide by jumping from the hospital housing building. This intelligent, dedicated, accomplished young physician was the third internal medicine resident in our 22 square mile city to perform this act with identical detail in just under 2 years. We were dismissed to return to our pagers.

We picked ourselves up, literally, from sobbing piles on the bathroom floor and answered our pages. The work did not stop."
​
For the full article, read here:
http://news.doximity.com/entries/4120720