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HealthyPlace.com Newsletter

This Week - March 24, 2003

1. Kids and parents see ADHD improvement differently
2. When it comes to eating disorders, when is it time for a parent to take action?
3. I'm a compulsive overeater. Help!
4. A new treatment for binge eating disorder
5. A breakthrough therapy to find love again
6. Childhood head injuries “increase risk of schizophrenia”
7. Brain scan can predict response to antidepressant
8. Book Review: "Depression is a Choice: Winning the Battle Without Drugs"

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Kids and parents see ADHD improvement differently

Psychiatrists and parents are often torn over giving psychostimulants to children suffering from Attention Deficit Hyperactivity Disorder (ADHD). The recent finding that kids with ADHD are reluctant to credit medication for their behavioral improvement won't do much to resolve this controversy.

Jason J. Washburn, Ph.D., a post-doctoral fellow at the University of Michigan, asked children treated for ADHD and their parents what made a difference in the child's behavior: Was it the pill, the child or both?

The answer depends on whom you ask, says Washburn, who presented his study of 8-13 year olds at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Parents and children attributed positive results to both the medication and efforts by the child. However, parents were likely to give more credit to the medication, while children gave more credit to themselves.

The findings are encouraging , says Washburn. "When these children go on medication, parents are often concerned that daily pill-taking will damage the child's self-esteem and that they will feel helpless without the medication," he says. "Our findings show that children don't ask, 'Is it the pill or me?' They say, 'It's the pill and me, too.' "

When it comes to EATING DISORDERS...

WHEN IS IT TIME FOR A PARENT TO TAKE ACTION?

In the first of a series of columns in the HealthyPlace.com Eating Disorders Community, Amy Spahr, program director at Remuda Ranch Programs for Anorexia and Bulimia, says "parents, especially mothers, need to trust their instincts regarding their children."

Read the full article here.

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Eating Disorders Bulletin Board

I'm a compulsive eater. Help!

pookycat writes:

"I'm 24 years old and I'm a compulsive overeater. I have a terrible battle with food addiction. I need the help and support of others like me to know that I'm not the only person with this problem. I weigh 180 pounds and am 5'2". I want to reach 130, but my addiction makes it so hard to do it."

How did pookycat become obsessed with her body image and food and can YOU help her deal with this demon? The link to her post is here.

on the subject of binge eating...

In the Feb. 2003 issues of The American Journal of Psychiatry, researchers report that Topiramate (Topamax) is effective in treating binge eating disorder.

Topiramate is an anticonvulsant used to treat mood disorders and has been found to promote appetite suppression and weight loss. Binge eating disorder, unlike anorexia nervosa or bulimia nervosa, is often associated with obesity.

At the end of the 14-week, 61 patient study, there was a 94% reduction in the frequency of binging in the topiramate group compared with a 46% reduction in the placebo group. Also, patients in the topiramate group lost 5.9 kg (about 13 pounds) during the time of the study compared with a 1.2-kg (about 2.5 pounds) weight loss in the placebo group.

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A breakthrough therapy to find love again

Couples therapy is growing in popularity, but few approaches have proven reliably beneficial. Emotional Focused Couples Therapy, or EFT, is one that has. This groundbreaking theory of adult love is highly successful, and there is plenty of research to back it up.

EFT is based on attachment theory; that everyone has an innate yearning for trust and security, or attachment. Children need to feel attached to a parent; adults need to feel attached to another adult, usually a romantic partner. And when those we're attached to can't respond to our needs - maybe one parter is emotionally unavailable - we become anxious and fearful or numb and distant, which sets up dangerous patterns in interaction.

The goal of EFT, therefore, is to help partners feel securely connected by fostering feelings of safety, accessibility and responsiveness.

Here is the nine-step process for rekindling love:

1. Partners lay their problems out on the table.
2. Partners recognize the cycle that's keeping them emotionally distant and try to identify the needs and fears fueling that cycle.
3. Partners articulate the emotions behind their behavior.
4. Partners realize they're both hurting and that neither is to blame.
5. Partners identify and admit their emotional hurts and fears.
6. Partners begin to acknowledge and accept the other's feelings and their own new responses to those feelings.
7. Partners are drawn together through the expression of their emotional needs.
8. Partners create new solutions to their problems.
9. Partners consolidate their new positions and cycles of behavior.

Read more about EFT here

Childhood head injuries “increase risk of schizophrenia”

Individuals with schizophrenia are twice as likely to have suffered childhood head injury than their healthy siblings, say scientists from Canada.

Infant head injury increases mental illness risk

Researchers from the universities of Toronto and Waterloo, both in Ontario, also found that children with a genetic predisposition for schizophrenia appeared to develop the mental disorder earlier if they received a mild head injury during childhood.

Dr Philip AbdelMalik and colleagues compared the history and severity of head injuries in childhood and adolescence in 67 subjects with schizophrenia and 102 of their unaffected siblings from 23 families with a genetic predisposition for the disorder. Only head injuries that preceded the onset of psychosis were considered.

Reporting in the journal Archives of General Psychiatry, the researchers found that 24 per cent of the subjects with schizophrenia reported a history of childhood head injury (mainly concussions) compared with only 12 per cent of unaffected siblings.

Moreover, they found that psychosis occurred on average around five years earlier in subjects with a childhood head injury.

The team argues that its results suggest that childhood head injury may “interact with genetic effects to modify the expression and course of the disorder”.

Although the mechanisms underlying the link between head injury and schizophrenia are unclear at present, the study authors speculate that head injuries might cause structural brain damage that affects the developing brain.

Alternatively, they suggest that head injuries might occur more often in children already showing early signs of schizophrenia, such as motor development delays and lack of co-ordination.

Reference: AbdelMalik et al, Archives of General Psychiatry 2003;60:231-236

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Brain scan can predict response to antidepressant

Patients with specific patterns of brain activity had a tendency to respond well to paroxetine (Paxil) for depression and obsessive compulsive disorder. Paroxetine is an antidepressant which has also been used in the successful treatment of obsessive compulsive disorder (OCD). But some patients fail to respond. If they could be identified prior to treatment, alternative options could be explored.

In the first study of its kind, researchers at the University of California, Los Angeles, screened a group of patients using positron emission tomography (PET), which gives an image of brain activity. Twenty seven of the patients had OCD, 27 had major depression and another 17 had both conditions. They had PET scans both before and after treatment with paroxetine.

Improved OCD symptoms were linked with higher pre-treatment activity in specific parts of the brain. The same was true for improvement of depression (although the regions of the brain involved differed). The study opens up the possibility of using brain imaging to pick out those patients most likely to benefit from a specific treatment. In other words, PET can help the psychiatrist tailor treatment to an individual patient.

Source: American Journal of Psychiatry March 2003

In-depth information on antidepressants can be found in the HealthyPlace.com Depression Center.

Depression is a Choice: Winning the Battle Without Drugs by A.B. Curtiss

book review by Christopher Dowrick, Professor of Primary Medical Care, University of Liverpool, Liverpool L69 3GB, United Kingdom

Curtiss is a family therapist and cognitive behavioural therapist. She also has long personal experience of the condition now known by psychiatrists as bipolar affective disorder - formerly called manic-depression - in which periods of intense despair and misery are interspersed with episodes of highly charged energy and excitement. Depression is a Choice is a detailed, honest and at times alarming account of her ongoing struggle with depression, which makes good use of historical, philosophical, professional and some very personal perspectives.

The book’s central message concerns the importance of what Curtiss calls ‘Directed Thinking’. She has found that it is not necessary to become a victim of depressed mood. She argues that although we cannot get rid of it directly, we do have some element of choice in the matter. It is possible for us to think our way out of the depths of despair.

She explains the technique of ‘conscious neutral thinking’, whereby we can learn to use simple repetitive thoughts - such as nursery rhymes - to counter and replace depressive thinking that can so easily hamper and cripple us. She also explains some of the cognitive-behavioural techniques used to challenge negative thinking, which are aimed to help us to see ourselves not as failures but as ‘works in progress’. In place of the complex biochemical formulae developed by pharmaceutical companies to derive antidepressant medication such as Prozac, she presents us with her own much simpler formula for the cure of depression:

D + (cnt)c=e

Depression + conscious neutral thinking x concentration=equanimity

Curtiss describes valuable role models from history and from literature. At the age of twenty-two, Benjamin Franklin decided to embark on a regimen of acquiring what he considered to be the thirteen important virtues (including temperance, resolution, chastity and humility) and kept a diary to record his progress. She finds him a helpful example of how it is possible deliberately and explicitly to work on our health and well-being. Greater than this is the importance of locating ourselves in our life, our roles and responsibilities, and not seeing our immediate feelings as the arbiters of our fate. Ishmael, in Melville’s Moby Dick, said that ‘in all cases man must eventually lower, or at least shift, his conceit of attainable felicity; not placing it anywhere in the intellect or the fancy; but in the wife, the heart, the bed, the table, the saddle, the fire-side, the country’.

She has devised a morning meditation to use if she wakes and finds herself depressed. This includes singing children’s songs and nursery rhymes, fast counting, laughing silently (or out loud if there is nobody else around), praying for three other people, and remembering that life can have meaning without the necessity of happiness. ‘If you can’t do it for yourself, do it for the others’.

Curtiss is strongly anti-medication, particularly antidepressants such as Prozac, which she sees as taking away our responsibility and our ability to work things out for ourselves. While I agree with her concerns about the medicalisation of misery, and the relentless drive for profit maximisation of major pharmaceutical companies, I think her position here is unnecessarily antagonistic. In my experience as a general practitioner - and as the father of a child who has experienced bipolar affective disorder - I have found that medication can be a very useful support to the approaches and techniques that she is advocating in this book. I do not think that we need to make an either-or choice, but can do best with a judicious use of all relevant approaches.

Click to buy Depression is a Choice: Winning the Battle Without Drugs by A.B. Curtiss

* * * * * * * * * * * * * * * * * * * * * * * *

That's it for this week. On a closing note, if you have a loved one in the military overseas, these are difficult times. We hope for their safe return -- soon.

If you know of anyone who can benefit from this newsletter or the HealthyPlace.com site, I'll hope you'll pass this onto them.

Sincerely, Deborah

Community Partner Team
HealthyPlace.com - Mental Health Communities
"When you're at HealthyPlace.com, you're never alone."

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