Questions of the
Week
April
Through June, 2000
April 3, 2000
Q "What
is narcissism apart from "narcissistic personality" and is it inherently bad?"
A
Narcissism is a feature of psychobiological existence. We need narcissism to
survive. You see it in infants who not only are demanding that their needs be
met but also fascinated by their own bodies. It is how we discover who we are
and what we need. Pathological narcissism exists when our own needs exclude the
desire and/or capacity to care for others or to put their needs before our own
when the situation demands. Narcissistic insult is when an individual becomes
anxious, angry or depressed because an event threatens their need to appear
perfect in their own eyes and the eyes of others.
April 10, 2000
Q "What
is social anxiety disorder?
A
Social anxiety
disorder, or social phobia, is a medical disorder characterized by overwhelming
anxiety and excessive self-consciousness in social situations. People with the
disorder have a chronically intense fear of 1) others' scrutiny and 2)
embarrassment or humiliation due to their own actions.
This social avoidance disrupts these people's lives, in contrast to the
negligible effect of a moment of shyness. People who are shy don't have an
illness. You could think of the difference between social anxiety disorder and
shyness as similar to the difference between clinical depression and an
occasional bout with the "blues."
Some 10 to 26 million Americans may experience clinically significant phobias
-- persistent, irrational fears of certain objects or situations, and social
anxiety disorder occurs in twice as many women as men, although men are more
likely to seek treatment. It typically begins in early childhood or adolescence
and rarely develops after age 25.
Certain medications and a particular form of psychotherapy have been found to
be effective in relieving the symptoms of this disorder. Some doctors prescribe
a combination of drug therapy and a type of psychotherapy called "exposure
therapy" -- involving helping people become gradually more comfortable with
objects or situations that frighten them. Sometimes exposure therapy alone is
used.
April 17, 2000
Q
"Can you
give me an overview of depression and what things you look for in yourself or a
family member when trying to decide if someone is depressed?"
A
When symptoms of depression persist for more than two weeks, and keep you from
functioning at your best at work or socially, you may be experiencing clinical
depression or major depressive disorder (MDD) and will have at least five of the
of the following nine symptoms, including at least one of the first two: 1)
depressed mood, 2) loss of interest or pleasure in daily activities, 3) loss of
appetite, or an unintended weight change, 4) problems with too much or too
little sleep, 5) restlessness or sluggishness, 6) fatigue or loss of energy, 7)
feelings of guilt or worthlessness, 8) difficulty thinking clearly or
concentrating, and 9) thoughts of death or suicide. Other symptoms may include
anxiety attacks, constipation, abdominal and other aches and pains, tearfulness,
or, conversely, an inability to cry or express emotion.
Symptoms like sleep and weight changes or fatigue can indicate physical
rather than emotional problems. This is one reason that, of the more than 17
million adult Americans affected by depression each year, nearly two-thirds
don't recognize they have it -- and don't get the treatment they need. Once you
know which of your physical symptoms has a physical cause, you and your
physician can decide whether you should also have a psychological assessment for
depression.
April 24, 2000
Q
"Should I be seeing a psychologist for `therapy or
just see a counselor. I am not certain why I would chose one over the other and
not certain how to determine the credentials of each?"
A
Psychotherapy involves a wide range of treatment approaches. Before you can
determine which is appropriate for you, someone must diagnose your
problem/disorder. Psychologists are licensed in the diagnosis and treatment of
mental and emotional disorders. To be a psychologist, you must have a doctorate
from an accredited university and be licensed through credential review and
examination by the State in which you practice. The
National Register of Health Service
Providers in Psychology maintains a very large listing of qualified
psychologists, and the Academy of Clinical
Psychology maintains a listing of those who are Board Certified in Clinical
Psychology.
May 1, 2000
Q
"Do all depressed people eventually commit suicide?"
A
While suicide is a potential
complication of a major depressive episode, it is not the most common outcome.
When considering suicidal potential, among the many aspects to examine is the
individuals perceptions (fear) of the future and (negative) expectancies of what
that future will bring. And obviously, a person should be directly asked if they
have had suicidal thoughts, whether they have a plan, and a determination must
be made as to whether they have means of lethality (eg. drugs, weapons, etc). In
the past, it was feared that discussing suicide with a patient "planted the
idea" but it is generally felt that the risk to unrecognized suicidal potential
far outweigh such concerns.
May 8, 2000
Q "How
treatable is a personality disorder?"
A
The diagnosis and treatment of personality disorders (once called
characterological disorders) has always been a matter of great debate. Many
believe there are genetic predispositions within families for the development of
these developmental disorders which have been referred to as "set in concrete"
by early adulthood. Others indicate that long term and specific psychotherapies
in which the patients relearn more adaptive means of interacting with their
world can be accomplished, but this is rarely referred to as short term
treatment, and many patients remain in psychotherapy for several years in order
to make substantial changes. As with many health care issues, one of the core
features is the motivation of the patient to change.
May 15, 2000
Q "How
treatable is a personality disorder?"
A
The diagnosis and treatment of personality disorders (once called
characterological disorders) has always been a matter of great debate. Many
believe there are genetic predispositions within families for the development of
these developmental disorders which have been referred to as "set in concrete"
by early adulthood. Others indicate that long term and specific psychotherapies
in which the patients relearn more adaptive means of interacting with their
world can be accomplished, but this is rarely referred to as short term
treatment, and many patients remain in psychotherapy for several years in order
to make substantial changes. As with many health care issues, one of the core
features is the motivation of the patient to change.
May 22, 2000
Q "Is
loneliness more or less of a problem today.?"
A
Loneliness is one of the most common
problems encountered by psychologist and often the most overlooked. In 1950, 9%
of American households consisted of a single person and in 1992, that figure
had risen to 25%. People with strong social ties tend to be physically healthier
and live longer lives. People are loathe to admit loneliness, and yet it is
readily treated by undertaking tasks that place one within regular contact with
other individuals.
May 29, 2000
Q "Are
men just as emotional as women?"
A
Apparently not. In a recent experiment, researchers found that women are more
expressive and sometimes have strong physical reactions, but they tend not to
describe themselves as more emotion. In the study, both men and women reported
similarly intense feelings, but women's faces were more expressive and measures
of physiological functioning indicated stronger physical responses than their
male counterparts.
June 5, 2000
Q
"Can I die of a broken heart?"
A There
is a quite serious answer to this question. Depression has long been associated
with increased health risks, including those of cardiovascular disease and
myocardial infarction (MI). Certain antidepressant medications, particularly
tricyclic agents (TCAs), may exacerbate those risks, even in patients without
known heart disease. Results also imply, however, that selective serotonin
reuptake inhibitors (SSRIs) may be "heart safer" -- at least with respect to MI
risk.
Users of antidepressants were found to have more
than a twofold risk of MI (after adjusting for age and sex), compared with
subjects who were not using antidepressants. They were also 1.7 times as likely
to be hospitalized for cardiovascular disease or to die from any cause.
All three classes of antidepressants studied
(tricyclics, SSRIs, and monoamine oxidase inhibitors or atypical agents), were
associated with cardiovascular hospitalization, the investigators report.
Subjects treated with tricyclic agents were more than twice as likely to
experience MI, compared with patients who did not use antidepressants, while use
of SSRIs was not associated with MI risk.
While acknowledging that tricyclic
antidepressants could be cardiotoxic, researchers attribute much of the
increased health risk to the physiological and psychological effects of
depression itself -- which they suspect may be further aggravated by tricyclic
use.
The message may be that SSRIs counteract the
elevated risk resulting from depression, and tricyclic agents do not.
References
- Cohen HW, Gibson G, Alderman MH. Excess risk
of myocardial infarction in patients treated with antidepressant
medications: association with use of tricyclic agents. Am J Med.
2000;108:2-8.
- Barefoot JC, Williams RB. Antidepressant use
and the risk of myocardial infarction [editorial]. Am J Med.
2000;108:87-88.
June 12, 2000
Q "I
have numerous friends with eating disorders. They insist that they run no real
health risk. I doubt that this is so. What are your thoughts?"
A
Adolescents with anorexia nervosa are more likely than those with bulimia
nervosa and other eating disorders to have abnormal (cardiac)
electrocardiographic (EKG) findings, according to study findings in the May
issue of Pediatrics. On average, the heart rate and left
ventricular contractility were lower in the adolescents with anorexia nervosa
than in controls, the researchers report. In contrast, the only difference
between the adolescents with bulimia nervosa and controls was a slightly longer
mean QTc in bulimics. The researchers recommend using bradycardia and decreased
left ventricular forces to evaluate the severity of anorexia nervosa "because
they were found to correlate significantly with lower standardized body mass
index." Pediatrics 2000;105:1100-1105.
June 19, 2000
Q
"I gather people still use "shock therapy." For what
is it used and are there any concerns for its use?"
A
Although "shock therapy" (ECT) is most commonly used for severely depressed
patients, it has been used for other disorders which present with psychological
symptoms. It's use arose when it was noted that often after seizures,
individuals were less depressed. ECT induces a controllable seizure, and its
method today almost bears no resemblance to early means of ECT. For patients
undergoing electroconvulsive therapy (ECT), the prospect of impaired short-term
memory is one of the most troubling aspects of treatment. Now investigators at
Columbia University have found that ECT affects memories of impersonal events,
but spares more personal recollections. Their findings, which also confirm that
bilateral (BL) ECT has more impact on memory than right unilateral (RUL) ECT.
June 26, 2000
Q
"I have read about sleep disorders elsewhere
on this site. Does Melatonin help? I have a difficult time with sleep for the
last several years, and friends have recommended Melatonin."
A The
connection between hormones and insomnia was presented by researchersat ENDO
2000, the 82nd annual meeting of the Endocrine Society, report that low doses of
melatonin restore normal sleep in insomniacs age 50 and over. One researcher
reported that most older people have subnormal melatonin levels at nighttime in
their blood, and many of these people have insomnia. For these people, low doses
of melatonin are highly effective in restoring normal sleep efficiency. Our
study shows that much higher doses are less effective. Participants in the
groups were given either a placebo or three different levels of melatonin (0.1,
0.3, and 3.0 mg), orally.All three doses of melatonin improved sleep in the
insomniacs, but only the middle dose of 0.3 mg restored sleep to normal. The
higher doses of melatonin at health food stores, such as 3 mg, are less
effective. If you went to the health food store, you would get 10-100 times the
amount used in this study.They may think they're taking the right dose, but wake
up groggy and not able to function.
