Sunday, February 28, 2010

Losing my job......tough, yet managable

Due to the merger of the two banks that now make up the organization that I work for currently, the decision makers made a determination (in their infinite wisdom) to close 14 locations in the great state of New Jersey. Of course, the one I manage was one of those.

I have always been an optomist. The glass half full, yadda yadda. So, therefore, I view this not as the end, but as the beginning of a new career for me. Luckily, I have many more skills-ones that are currently untapped in my banking career--that I can fall back on. Ones that I most certainly will use to my advantage to gain a rewarding and financially fulfilling career path, such as writing a novel or opening up a music academy.

As one door inevitably closes in life, another opens. A wise man once told me this: if we look too long at the door that has been closed, we do not notice the other one open. This too shall pass.

V

The Ravages of The Milenium's Most Misunderstood Disease

A post I found on Twitter. I follow these types of things, don't cha know!


A decade ago psychologist Ronald Levant, then at Nova Southeastern University, was telling some of his colleagues at a conference about patients with schizophrenia whom he had seen recover. One of them asked rhetorically, “Recovery from schizophrenia? Have you lost your mind, too?”

Until recently, virtually all experts agreed that schizophrenia is always, or almost always, marked by a steady downhill progression. But is this bleak forecast warranted? Certainly schizophrenia is a severe condition. Its victims, who make up about 1 percent of the population, experience a loss of contact with reality that puts them at a heightened risk of suicide, unemployment, relationship problems, physical ailments and even early death. Those who abuse substances are also at risk for committing violent acts against others. Contrary to popular belief, people with schizophrenia do not have multiple personalities, nor are they all essentially alike—or victims of poor parenting.

Nevertheless, research has shown that with proper treatment, many people with schizophrenia can experience significant, albeit rarely complete, recovery from their illness. Many can, for example, live relatively normal lives outside a hospital, holding down a job and socializing periodically with family and friends. As psychiatrist Thomas McGlashan of Yale University concluded in a prescient 1988 publication, “The certainty of negative prognosis in schizophrenia is a myth.”

From Desperation to Hope
Around 1900 the great German psychiatrist Emil Kraepelin wrote that schizophrenia, then called dementia praecox (meaning “early dementia”), was characterized by an inexorable downward slide. In 1912 another doctor, A. Warren Stearns, wrote of the “apparent hopelessness of the disease.” Some treatments of the day, which included vasectomy and inducement of intense fever using infected blood, reflected this sense of desperation. An attitude of gloom pervaded the field of schizophrenia research for decades, with many scholars insisting that improvement was exceedingly rare, if not unheard of.

Yet experts have lately come to understand that the prognosis for patients with schizophrenia is not uniformly dire. Careful studies tracking patients over time—most of whom receive at least some treatment—suggest that about 20 to 30 percent of people recover substantially over years or decades. Although mild symptoms such as social withdrawal or confused thinking may persist, these individuals can hold down jobs and function independently without being institutionalized.

In one study published in 2005 psychologist Martin Harrow of the University of Illinois College of Medicine and his colleagues followed patients over 15 years and found that about 40 percent experienced at least periods of considerable recovery, as measured by the absence of significant symptoms as well as the capacity to work, engage in social activities and live outside a hospital for a year or more. Although most patients do not go into long remissions and may even decline over time, some 20 to 30 percent of this majority experience only moderate symptoms that interfere with—but do not devastate—their ability to perform in the workplace or maintain friendships.

Improved Treatments
Contributing to this less fatalistic view of schizophrenia are the effective treatments that have become available over the past two decades. Such atypical antipsychotic medications as Clozaril (clozapine), Risperdal (risperidone) and Zyprexa (olanzapine), most of which were introduced in the 1990s, appear to ameliorate schizophrenia symptoms by affecting the function of neurotransmitters such as dopamine and serotonin, which relay chemical messages between neurons.

In addition, certain psychological interventions developed over the past few decades can often attenuate symptoms such as delusions and hallucinations. For example, cognitive-behavior therapy aims to remedy the paranoid ideas or other maladaptive thinking associated with the disorder by helping patients challenge these beliefs. Family therapies focus on educating family members about the disorder and on reducing the criticism and hostility they direct toward patients. Though not panaceas by any means, these and several other remedies have helped many patients with schizophrenia to delay relapse and, in some cases, operate more effectively in everyday life.

Saturday, February 13, 2010

How do you tell bipolar and schizophrenia apart? They symptoms are very similar.

Part 2: How do you tell bipolar disorder, schizophrenia apart?
Asked by Tony Felts, Helmetta, New Jersey

Are the psychoses of bipolar disorder and schizophrenia very similar? How do you tell psychotic bipolar disorder apart from schizophrenia with mood disorder? How similar are the two diseases considering that the same medicines (anti-psychotics) are beneficial to both?


Mental Health Expert
Dr. Charles Raison
Psychiatrist,
Emory University Medical School
Expert answer
Dear Tony,

This week we pick up where we left off last week. If you didn't see last week's entry regarding this question, click here.

When I was a psychiatry resident at UCLA I had an ongoing friendly disagreement with a friend of mine named Matthew State, who was one of the best residents I ever knew and who has gone on to become a famous psychiatric genetics researcher. Matt maintained steadfastly in those years that because psychiatric disorders actually existed as distinct entities, every patient could be described fully by one or more diagnoses. If you couldn't do this you hadn't tried hard enough.

In contrast, I maintained then, and still maintain, that psychiatric diagnoses are like Platonic ideals, they are "perfect types" that patients more or less approximate. Because of this some patients have histories that walked right out of the DSM-IV diagnostic manual, but others have stories that fall between the diagnostic cracks and that, therefore, will never fit a diagnosis very well no matter how hard you try.

You can see why I'm telling this story. While modern psychiatry was built to no small degree upon the belief that schizophrenia and bipolar disorder were separate psychotic illnesses, I think data increasingly suggest they are more similar than different. You can see this any way you look at it.

More and more studies suggest that they share genetic risk factors. That, in fact, there may be some genes that predispose one to psychosis and other genes that predispose one to mood disorders. If you just get the psychotic genes you look schizophrenic. To the degree you get both types of risk genes you look more bipolar. Although as I mentioned last week, lithium works for bipolar disorder but not for schizophrenia, in the last decade a small army of medications has been introduced onto the market that work well for both conditions, strongly suggesting a shared neurobiology.

Finally, long term follow-up studies have shown that schizophrenia doesn't always lead to an unremitting downward spiral, and, unfortunately, bipolar disorder is not a condition characterized by no long-term damage. In fact, it is increasingly clear that the deterioration in functioning over time that was once thought to be a hallmark for schizophrenia is also very common in people with bipolar disorder.

So these comments answer your first and third question, leaving the question of how to tell a psychotic mania apart from a schizophrenic psychotic episode. Every psychiatrist in the world believes he or she can do this, but the best data on the issue suggest this isn't true. In fact, any symptom present during a psychotic episode can occur in people who, over time, look more schizophrenic or who look more bipolar. Having said this, however, because I am a psychiatrist I, like everyone else, think I can make an educated guess about whether someone is manic.

Here are a few clinical "pearls" for identifying a manic psychosis. First, manias tend to come on more quickly than schizophrenic episodes. They are often preceded and accompanied by remarkable reductions in sleep. Classic manic episodes are characterized by profound mood changes. These are easiest to recognize when the mood is euphoric, but rage is just as common, and more dangerous. If you see a psychotic patient who is moving and speaking a million miles an hour, that doesn't prove he is manic, but it is a pretty strong clue. Finally, although data show you can't separate out manic from schizophrenic episodes by the quality of the psychotic delusions, I have always been impressed by the fact that at the core of manic delusions is a sense that everything in the universe is connected in strange and meaningful ways. Again this isn't specific for mania, but if this type of thinking is present along with other symptoms I've described, it is a tip that someone is having a manic episode.

So let me end on one final note of confusion/uncertainty. Long-term studies of patients who are schizophrenic suggest that a high percentage of them will have at least one manic episode in their lives! So what is the take-home message? Both schizophrenia and bipolar disorder are serious and often devastating conditions that have the best outcomes when treated early and aggressively. You don't want to leave someone in any type of psychotic state for one moment longer than you have to.

Sunday, February 7, 2010

Loneliness and How to Overcome It

Loneliness. Not an easy word for those afflicted with a broken mind. Although, I realize, that loneliness is not easy for anyone, it is especially difficult for those who suffer from mental illness. How do you react when you are lonely--When you miss the touch and clever conversation of another who understands you fully?

You must commit yourself to useful work, as well as know that none of us are truly alone. We are with a higher power as well--and that higher power is a Deity known as God.

Recently, I heard a sermon from a Methodist Minister here at Trinity Church and he was speaking about loneliness. He used the Genesis book parable about Joseph being sold into slavery by his jealous brothers and the message hit home.

Although I rarely deal with loneliness, being alone does not mean you must be lonely. After all, we all have useful work that we may commit ourselves to and a prayer to send up to God. And let's face it, folks, if we would like to meet someone, there are always those places, whether they be virtual or land-based, that we may meet someone else who truly understands you and what you go through day in and day out.

Wednesday, February 3, 2010

An interesting article I stumbled upon about POW'S

Winners and Losers:Breaking down Obama's budget
..Ex-POW in Iraq war recalls nightmares, depression
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Delicious Digg Facebook Fark Newsvine Reddit StumbleUpon Technorati Twitter Yahoo! Bookmarks .Print .. AP – Shoshana Johnson poses for a picture in New York, Tuesday, Feb. 2, 2010. Johnson, the nation's first …
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By KIMBERLY HEFLING, Associated Press Writer Kimberly Hefling, Associated Press Writer – Wed Feb 3, 9:34 am ET
WASHINGTON – Shoshana Johnson survived gunshot wounds to both legs and 22 days as a prisoner of war in Iraq. Life wasn't so easy when she came home, either.

In a new book out this week, the 37-year-old single mother describes mental health problems related to her captivity and tells how it felt to play second fiddle in the media to fellow POW Jessica Lynch, who was captured in the same ambush.

"It was kind of hurtful," the former Army cook said in a telephone interview with The Associated Press. "If I'd been a petite, cutesy thing, it would've been different."

Johnson, the nation's first female black prisoner of war, said she felt she was portrayed differently because of her race, either by media outlets that chose not to cover her experience or those who portrayed her as greedy when she challenged the disability rating she was given for her post-traumatic stress disorder.

While the story of Lynch, then 19, remains firmly in the nation's collective memory from the 2003 U.S. invasion of Iraq, far less attention has been paid to Johnson, then 30, and four male soldiers from the 507th Maintenance Co. from Fort Bliss, Texas, who also survived captivity.

Johnson was rescued by Marines, about two weeks after Lynch's rescue. Months after returning home, Johnson left the military and today is enrolled in culinary school. She lives in El Paso, Texas, with her 9-year-old daughter.

Johnson's book, "I'm Still Standing," is being released in time for Black History Month. Johnson said she hopes that by telling her story, she can set the record straight and bring attention to mental health issues affecting veterans.

The day of the 2003 ambush, Johnson and Lynch were among 33 U.S. soldiers in a convoy that got lost in Nasiriyah en route to Baghdad. Their journey, Johnson said, was hampered by broken-down vehicles and malfunctioning equipment. Eleven were killed — including Johnson's friend Army Pfc. Lori Piestewa.

Johnson asked to be medically discharged from the military in part because she felt other soldiers resented her over the attention her POW status attracted.

She's also struggled with depression and nightmares. At times it was so bad, she writes, that her daughter, who was 2 at the time Johnson was captured, asked Johnson's parents, "Why is Mommy crying all the time?"

In 2008, she checked herself into a psychiatric ward for a few days.

"Even when I came home, I didn't think I'd ever get better. I didn't think the issues I had would ever ease," Johnson said in the interview. "But as time goes on and I stick with my therapy, it has gotten easier, and I know if I keep on the right track, I'll be OK."

It was hard at first to admit to having PTSD, she said, because she thought of it as something that happened to Vietnam veterans.

"When they started throwing out that word when I came home, I was like, no, that's not me," Johnson said.

Today, Johnson is training to be a pastry chef so she can make wedding and birthday cakes.

"It would just be nice to be able to celebrate those special moments with people," she said. "After everything that's gone on, I think those kinds of moments are very special."

After successfully fighting to receive improved disability benefits stemming from her PTSD, she was later asked to serve on the Veterans Affairs Department's panel on minority affairs.

She speaks proudly of the other POWs in captivity with her and keeps in touch with them. She said they schedule annual POW exams — the Defense Department is studying the effects of captivity — at the same time in Florida so they can see each other.

Contrary to speculation, Johnson said she was never angry at Lynch or jealous of her.

"Jessica is my friend," Johnson writes. "I was her friend before the ambush and I'm still her friend now."

One of the most brutal things Johnson endured was a captor grabbing her chest. She tells in her book of mobs of Iraqi people coming to view her as a vehicle she was in traveled from town to town, with one villager slapping her and another spitting on her. But while the men endured beatings during the captivity, she said she was treated better.

She describes acts of kindness, too, by the Iraqis. One doctor operated on her legs, which she credits with allowing her to keep them. Another doctor early in her captivity whispered to her that a woman Johnson assumed was Lynch was alive, which provided comfort.

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