Google Tech Talk March 22, 2010 ABSTRACT Presented by Kevin Biglan, MD, MPH and Ray Dorsey, MD, MBA, University of Rochester. The cost of clinical trials is rising, recruiting participants is increasingly difficulty, and monitoring safety is increasingly important. Home and patient appropriate technologies like the Marvell Plug computer and Google products can help address all of these issues. We will discuss our efforts to monitor blood pressure remotely using these technologies in a Michael J. Fox funded Parkinson disease clinical trial. Telemedicine using simple web-based video conferencing using, for example, the Marvell Plug computer and Google’s services can also address large unmet needs in clinical care. Chronic conditions account for 75% of health care expenditures and affect over 140 million Americans. However, many have limited access to physicians, especially specialists, who can improve their care. We will present results of a pilot, randomized controlled trial of increasing specialty access using telemedicine to individuals with Parkinson disease residing in a remote nursing home and remote communities. We discuss future directions, including providing care directly into people’s homes (‘virtual house calls’), and ways that Google’s services can provide additional value. A new variation of the Marvell Plug computer in planned as an interactive television server for the virtual house calls in a upcoming study.
An attractive, highly successful Beverly Hills entertainment lawyer, Terri Cheney had been battling debilitating bipolar disorder for the better part of her lifeâand concealing a pharmacy’s worth of prescription drugs meant to stabilize her moods and make her “normal.” In explosive bursts of prose that mirror the devastating mania and extreme despair of her illness, Cheney describes her roller-coaster existence with shocking honesty, giving brilliant voice to the previously unarticulated madness she endured. Brave, electrifying, poignant, and disturbing, Manic does not simply explain bipolar disorderâit takes us into its grasp and does not let go.
Accessible and clinically relevant, A Clinician’s Guide to Statistics and Epidemiology in Mental Health describes statistical concepts in plain English with minimal mathematical content, making it perfect for the busy health professional. Using clear language in favour of complex terminology, limitations of statistical techniques are emphasized, as well as the importance of interpretation – as opposed to ‘number-crunching’ – in analysis. Uniquely for a text of this kind, there is extensive coverage of causation and the conceptual, philosophical and political factors involved, with forthright discussion of the pharmaceutical industry’s role in psychiatric research. By creating a greater understanding of the world of research, this book empowers health professionals to make their own judgments on which statistics to believe – and why.
The Brunner/Mazel Mental Health Practice Under Managed Care Series addresses the major developments and changes resulting from the introduction of managed care in health care delivery. Volumes in the series enable mental health professionals to provide effective therapy to their patients while conducting and maintaining a successful practice. The series is under general editorial direction of S. Richard Sauber, Ph.D.
A working manual for brief, effective treatment of adjustment disorders. Following the authors’ step-by-step format, the therapist progresses from initial contact and diagnosis through treatment, assessment of progress, and termination. The psychotherapeutic focus is tailored to the demands of managed care programs, and closely follows the DSM-IV — enabling therapists to demonstrate the need for proven-effective treatment appropriate for a specific impairment within a specific time frame as required by managed care and insurance companies.
It is normal to feel a little apprehension and anxiety, especially when you have to try out something new, or you are going to a new place. This apprehension or anxiety is because of the lack of assurance over an unknown outcome. This is because you feel afraid of a negative outcome or the possibility of a failure. The problem comes in when this apprehension or anxiety is already out of hand, in the sense that you are already confined to the safety of your home, and you are already prevented from doing normal activities that will be normally enjoyed by a person.
This state where your decision-making capabilities are already impaired because of groundless and uncontrolled apprehension is called anxiety disorder. Anxiety disorder can prevent you from learning and concentrating on the positive outlook of things, and in worst cases, it can cause you to avoid certain places or people who make you feel nervous. This could also cause extreme irritability and lack of concentration. Anxiety disorder is also the cause of self-doubt, unexplained irritation and depression, which could lead to health problems such as sleep deprivation, nausea, vomiting and weakness. There also rare cases where anxiety disorder causes a rise in blood pressure and heart rate, which can cause loss of breath.
But just like any problem, anxiety disorder can be taken cared of with the proper support. There are institutions and organizations that offer a mental health support system that can help you control your anxiety levels. A mental health network is a group of people who have either devoted their time to study anxiety disorder, or who have had the same problems before. This mental health network can help you take the necessary steps to control your reactions to certain stimuli and give you a more optimistic outlook about life.
Mental health support is not easy to give. This can emotionally take a lot from a person and oftentimes, people who offer this kind of support end up feeling as exhausted as the people they are helping. This kind of support given out by a mental health network is priceless. Because they are offering a lot, and most of the time do not want something in return.
The vast majority of findings in the published literature, apart from the studies of early trauma and early development, are either descriptive, or relate to predisposition, or measure what IÂ believe are the biological results of the disease process. While description, predisposition and biological change pertain to the disease process, they are not proven causative, and exploration has not led to significant prevention. In contrast, the early traumata identified and demonstrated in this text have exceedingly high correlations with disease processes that can surface 20 to 30 years later, and these early traumata can be identified and eliminated or attenuated, making prevention possible.Nonetheless, I review briefly some of the literature pertaining to serious mental disorders
DESCRIPTIVE PSYCHIATRY:
Over the last century a number of descriptive scientists played an important role in the identification, description and categorization of serious mental disorders. Their work drew interest to the field and provided a framework for future study. Aside from its historical value, their work continues in the form of DSM IV, which is an elaboration and extension of the same efforts to categorize mental illness in a way that facilitates study, research, treatment and prevention.
Noteworthy descriptive scientists of the past include Emil Kraepelin, Eugene Bleuler, Gabriel Langfeld and Kurt Schneider. Emil Kraepelin (1856-1926), a German psychiatrist, categorized seriously disturbed individuals into three main groups: dementia praecox [schizophrenia], manic depressive psychosis, and paranoia. His main contribution to the field was his careful description and categorization of serious mental disorders.
Eugene Bleuler (1857-1939), a Swiss psychiatrist, coined the word schizophrenia, and provided the four “A”s of schizophrenia: Associations (looseness of), Autism, Affective disturbance, and Ambivalence. Gabriel Langfeld described schizophreniform psychosis, and Kurt Schneider gave us first rank and second rank Schneiderian symptoms.
From Kraepelin through DSM IV, classification has been largely descriptive. I believe this is because little has been understood about cause. This leaves the process of categorization in its infancy. We find it more helpful to know the age of origin of a disorder than to know that the disorder meets a certain set of diagnostic criteria, and we think that future studies likely will confirm our impression that medications and regions of brain activity are specific to age of origin-not to current diagnostic criteria.
PSYCHOLOGICAL CAUSATION:
Causation has been addressed in many ways, including psychological attempts at explanation. Sigmund Freud came the closest to the theories presented in my work when he described ego disintegration and regression as a return to a state of primary narcissism. The idea of a return to a time when the ego was not yet developed matches closely my findings. I have developed the concepts further, however, describing original trauma, precipitating trauma, the return to a specific time, age and brain site, and adding the connection between psychological mechanism and biological change.
The psychological explanation of regression, attributing it to a return to an earlier time “because” the patient was more comfortable then, is a misunderstanding of the process. While there is a tendency to adapt or “settle in” to the most comfortable aspect of the regressed state, the reason for the regression is survival, and in the case of schizophrenia and other serious disorders, the survival mechanism is maladaptive. My data correlating early traumata with the later development of serious mental illness bares this out.
The most damaging of all attempts to explain the cause of schizophrenia psychologically was the attempt to blame the parent for his or her interaction with the child. The parent often suffers more than the child because of unwarranted feelings of guilt. The attempt to indite the parent was often presented in a way that was cruel and insensitive to the feelings and the needs of the parent, and this effort brought emotional destruction to lives of countless persons who already were in a state of great emotional despair.
Frieda Fromm-Reichmann (Campbell, 1989) was the first to discuss the “schizophrenogenic mother.” While she and others were astute in capturing intricate nuances in the relationship, the significant mistake was to identify the unique interaction between the patient and the mother as the cause instead of the result of the disease process. My work clearly makes this distinction: When the patient returns to the infant mind/brain/reality, everyone treats the patient like an infant, and this includes many mental health professionals.
Family support groups evolved as a means of self preservation, and as they grew in number and gained political influence, researchers retreated from exploration of interpersonal causes. The work of G. W. Brown (1966) had identified a strong mathematical correlation between living at home and recurrent hospitalizations, however, and this sparked a search for elements in the home environment to account for relapse. Expressed emotion in the family, referred to as the “EE” factor, was identified as the culprit, and family therapy to lower the EE factor was proven effective in reducing the relapse rate.
According to my findings, this effort does not go far enough. It is like detonating a small charge next to a combat veteran instead of a large one. The absence of an explosion precipitates no flashback at all. Likewise, a zero EE factor, brought about by a complete separation, is immeasurably better than a low EE factor.
This is not an inditement of the parent or an implication that he or she caused the disorder in any way. Even if the parent is exemplary and behaves in the most ideal way, contact can lead to relapse. The mechanism for this is the same as that between an alcoholic and the bottle. The bottle of scotch may be the finest in the world, but after the subject has “crossed the invisible line” and has become alcohol dependent, one sip returns him to the infant-on-the-bottle mind/brain/reality, and he drinks until the belly is full and passes out.
My sympathy is with family members who often suffer more than the patient, and every effort is made to protect the parent. There may be ways in which families do share in responsibility for the perpetuation of serious disorders, however, and if so, then it is in their best interest to be aware of these factors and to learn what to do.
Two important psychological factors led to the development of family organizations: 1) strong feelings of guilt (even though unwarranted) as parents were targeted unfairly for the cause of schizophrenia, and 2) powerful psychological defense mechanisms of denial and projection, as family members could not tolerate the pain of feeling guilty. These factors influenced the direction of research for nearly two decades, and a strong desire emerged to find a biological cause or an act of God responsible.
To search for the cause of schizophrenia, with the precondition that the result not precipitate feelings of guilt, is not the scientific method. Nonetheless, we have spoken with numerous mental health researchers who have said they would not dare explore possible influences related to family interactions.
Ironically, while my theories identify psychological traumata, they vindicate the parent from blame because they identify accidental traumatic experiences that happen to occur at crucial stages of development, and about which no one is aware.
Dr Clancy McKenzie is a widely acclaimed authority on the understanding of origins, mechanisms and treatment of schizophrenia. He graduated from the University of Michigan School of Medicine in 1962, and then focused his attention on the study of the human mind. Dr. McKenzie has studied the relationship between trauma and Schizophrenia. Through the years he has dedicated himself to the evaluation, analysis and treatment of trauma and its immediate and long-range effects on behavior and mental health. Learn More: http://www.drmckenzie.com and follow his blog: http://www.drmckenzieblog.com
Check out these community mental health centers images:
South Bronx Mental Health Council, Inc. Community Mental Health Center – 1/27/12 Image by NYS OASAS
Commissioner Arlene Gonzalez-Sanchez visits the South Bronx Mental Health Council, Inc. Community Mental Health Center (1/27/12)
Detention centre staff ‘cracked’ Image by publik16
Immigration Minister, Chris Evans… certainly there may be some obligations on the department in relation to these matters. More than 60 former staff at Australian immigration detention centres have reported long-term mental health problems associated with the stress of the job. There were 62 cases of mental illness among former guards at the Woomera and Baxter detention centres in South Australia.
Depression and anxiety are mental health conditions that often coexist, but they aren’t the same. Learn more. mental.healthguru.com
www.facebook.com A woman’s battle with mental illnesses & suicide. Through her journey, she has made it her passion to unite the sufferers of mental health illness and suicide. She is the founder of Death To Breath: Support for sufferers of mental health conditions & suicide. Also a member of MHA and a Field Advocate for AFSP/SPAN-USA 6th Congressional District of WA State. You can follow her advocacy work and contribute at www.facebook.com This video and content is copyright 2011 by the originator. All rights reserved.
psychinterview.com is your complete psychiatry training package with 46 practical clinical scenarios and over 9 hours of video and reading material supplemented with referenced notes for relevant learning. Take your first step towards becoming a competent mental health professional.
ICFJ participant Mahmoud Tamimi investigates the state of Egypt’s mental health facilities for Egypt TV. This was apart of the International Center for Journalists’ Virtual Newsroom project that trained 40 Egyptian journalists in investigative reporting skills through a unique hands-on/online mentoring program. The focus was to train journalists how to produce and disseminate investigative reports through computer- assisted reporting, and by linking to one another through a virtual newsroom online platform. Video Rating: 0 / 5
