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Clinical
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Atlanta Medical
Psychology
The clinical
practice of Dr. David B. Adams is located in The Medical Quarters in
the northside of Atlanta at the junction of Scottish Rite, Northside
and Saint Joseph's Hospitals. Dr. Adams consults to occupational
medicine, surgeons, nurse case managers, insurers and employers
regarding the psychological impact of work-related injury and the
role of psychological factors in short- and long-term
disability. |
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| PAST QUESTIONS OF THE WEEK |
June 29, 2004
Q
Is it common to feel so depleted when caring for my mother
with Alzheimer's Disease?
A SIGNS OF ALZHEIMER'S 1. Memory loss.
Forgets appointments, names and telephone numbers and does not remember them
later.
2. Difficulty performing familiar tasks. Forgets the steps for preparing a meal,
using a household appliance, or participating in a lifelong hobby.
3. Problems with language. Forgets simple words or substitutes unusual words,
making speech or writing hard to understand.
4. Disorientation to time and place. Gets lost on their own street, forgets
where they are, how they got there, and does not know how to get back home.
5. Poor or decreased judgement. May dress without regard to the weather, wearing
several layers on a warm day or very little in cold weather. Shows poor judgment
about money, giving away large amounts of money to telemarketers or paying for
home repairs or products they don't need.
6. Problems with abstract thinking. Balancing a checkbook may be difficult when
the task is more complicated than usual. Someone with Alzheimer's could forget
completely what the numbers are and what needs to be done with them.
7. Misplacing things. Puts things in unusual places: an iron in the freezer or a
wristwatch in the sugar bowl.
8. Changes in mood or behavior. Shows rapid mood swings from calm to tears to
anger for no apparent reason.
9. Changes in personality. Becomes extremely confused, suspicious, fearful, or
dependent on a family member.
10. Loss of initiative. Becomes very passive, sitting in front of the television
for hours, sleeping more than usual, or not wanting to do usual activities.
More than half of
all caregivers report major depression at some point in their caregiving of
loved ones with Alzheimer's Disease.
Some patients may stay in the first stage for several years and then decline
rapidly. Throughout each stage, the relationship between caregiver and patient
changes.
NINE TIPS FOR ALZHEIMER'S CARE Alzheimer's caregivers need help and support. A
study published last month in the American Journal of Psychiatry reported that
six sessions of therapy helped reduce depression in caregivers and possibly
helped the state of the person with Alzheimer's as well. Other things to keep in
mind:
1. Care partners should not feel guilty if they lose
patience or can't do everything on their own. Look to the Alzheimer's
Association for information on Alzheimer's, support services, care consultation,
education programs and connection with resources in your community.
2. Learn about caregiving techniques for each stage of Alzheimer's disease.
3. Engage in legal and financial planning.
4. Seek assistance and support from family, friends and community resources.
5. Eat well, exercise, and get plenty of rest.
6. Learn about and use relaxation techniques.
7. Be realistic about what you can do.
8. Give yourself credit for accomplishments.
9. Accept changes as they occur in the person with Alzheimer's.
For more information go to: www.alzga.org or call 1-800-272-3900.
June 22, 2004
Q "My daughter is over
weight, and this depresses her. Will she wind up with an
eating disorder?"
A "Just being
unhappy with their bodies is not enough to lead most women
into eating disorders - it takes additional factors,
according to a new study.
Women are more likely to have eating
disorders when their body dissatisfaction is accompanied by
other issues - most importantly, a tendency to obsessively
examine their bodies and think about how they appear to
others.
While studies have shown body
dissatisfaction is strongly related to the development of
eating disorders, there are many women who express
dissatisfaction with their bodies but who don't have
symptoms of disordered eating.
"Body dissatisfaction is so prevalent
among women in our society that it isn't very useful in
identifying women who may have eating disorders".
"About 3 to 8 percent of women have some
type of eating disorder, but many women -- maybe most women
-- are dissatisfied with their bodies. This study shows
there are factors such as constant body monitoring that
strengthen the relationship between body dissatisfaction and
eating disorders and may help identify women at risk."
The research was published in a recent
issue of the Journal of Counseling Psychology.
The results showed "body surveillance" was
the strongest factor that predicted which women with body
dissatisfaction were likely to report symptoms of eating
disorders.
For example, some women may ignore their
feelings of hunger because they are more concerned with how
eating may affect how they appear to others. Another factor
that strengthened the link between body dissatisfaction and
eating disorders is neuroticism - a personality trait in
which people tend to be anxious, nervous, worrying, and
insecure.
The third related factor was having a
family member or friend who has an eating disorder.
Women who have any of these three factors
- coupled with body dissatisfaction - are the ones who may
be most at risk for disordered eating.
June 15, 2004
Q "I
thought that blood pressure and its problems like stroke
were not really related to stress but to kidney disease and
salt intake etc."
A "Exaggerated
blood pressure responses to mental stress appear to be associated with a
greater number silent brain infarcts (strokes) in otherwise healthy and
asymptomatic older subjects; suggest one potential mechanism whereby stress
may be associated with the development of cerebrovascular disease. (The
study)...consisted of situations designed to evoke negative emotions.
Components included recollection of anger-provoking incidents, repeated
interruptions of statements and harassment during mental arithmetic tests.
Higher systolic blood pressure reactivity to stress was associated with an
increased number of silent infarcts of 3 mm or less seen on MRI. Severity
ratings were also greater for periventricular and deep white matter
hyperintensities.
There were similar associations with higher diastolic blood pressure
reactivity. "it may be worthwhile to investigate whether treatment of
stress-induced blood pressure responses -- in addition to the resting blood
pressure -- can reduce cerebrovascular risk."
Stroke 2004;35:1294-1298.
June 8, 2004
Q
"I had a disagreement with
my husband. He states that expressing anger openly will keep
him from disease. I see how upset he gets over minor things
and feel that his expressing anger is extremely unhealthy.
Your thoughts?"
A In a book by
Engel: "Many think the people with anger problem are the ones who yell,
scream and get physically aggressive. But not showing your anger is an
unhealthy way of dealing with anger.
You cannot avoid anger any more than you can avoid conflict, yet many people
still believe that being anger-free is the ultimate sign of emotional
health. In fact, those who appear not to have a problem with anger are
actually the ones most in need of help.
Some surprising things are red herrings for seeing red. Gossiping about
others, swearing a lot and being a perfectionist are all signs of an
unhealthy anger style. So is turning most of your conversations into debates
and assuming others are against you
Some other indicators that you have a problem with your anger:
You allow others to hurt you with their anger;
You are afraid to express your anger;
You find sneaky ways of getting back at people instead of expressing your
anger directly;
Your way of expressing anger leaves you feeling helpless and powerless;
You allow others to emotionally or physically abuse your children.
The key to expressing anger healthfully is to do it assertively; not
aggressively or passively.
The first step in changing your anger style is to express it in the opposite
way from what you normally do and to start out small. So if you do not like
confronting people, try expressing how you feel to rude strangers for a
week. Then work up to a co-worker and/or your spouse.
The most effective way of expressing this emotion is to translate it into
clear, non-blaming statements that establish boundaries. These statements
should contain two thoughts: the fact that you are angry and the reason why,
and what you want the other person to do about it. A simplified form could
be, I feel angry because________. I want you to ___________.
Body language is also important to assertive anger communication. Its best
to maintain good eye contact and pay attention to your facial expressions
and hand gestures. Keeping track of your tone of voice, volume and
inflection is also a good idea.
Anger is a normal and healthy emotion. Its how we deal with it that turns
it into a negative."
May 31, 2004
Q "Are
they using cognitive (sic) therapy for children too?"
A "psychologists
of teens in the United States have begun adapting a talk therapy normally
reserved for adults to treat youth depression.
Cognitive behavioral therapy, once used mainly in adults
to treat anxiety disorders, increasingly is being used to treat depression
in kids...
Several studies show this short-term approach can be as
effective as other forms of therapy, even the increasingly popular
anti-depressant drugs.
CBT rests on an increasingly popular notion teens can be
taught, much like with math and reading skills, to recognize and react to
stresses in a positive, appropriate manner.
The aim is to teach adolescents in a four- to nine-month
course of weekly discussion sessions how to alter their tendency to respond
negatively to difficult experiences.
Proponents contend that certain emotionally vulnerable
children develop a habit of viewing life through a dark filter.
CBT is not concerned with why these attitudes arise; it is
concerned with getting teens to understand that they have control and
enabling them to responding to otherwise debilitating mood disorders."
Copyright 2004 by United Press International.
May 24, 2004
Q
"Is there anyway to tell if
a child is going to grow up with problems...if he is from a
normal household?"
A You may find
this helpful: "A child's behavior during the preteen years may predict
whether he or she will experience depression, violent behavior or social
phobia as a young adult, new research findings suggest.
Those who reported fighting, stealing or other conduct problems were almost
four times as likely as their more well-behaved peers to have experienced
depression or violent behavior by 21 years old.
Parents, teachers, and service providers might be able to identify children
with conduct problems at an early age and intervene to reduce those problems
as a way to prevent later violence and depression. Previous studies have
also shown that children who show signs of anxiety and depression have a
higher risk of depression and anxiety disorders in their later years.
Other researchers have found that childhood
emotional and behavioral problems precede antisocial and other behaviors in
adulthood.
At follow-up, about 10 years later, 21 percent of the 21 year olds said they
had committed at least two violent acts during the previous year. Twenty and
17 percent, respectively, said they had experienced depression or social
phobia within the past year.
Overall, it was the children's own conduct reports that best predicted their
later depression or violent behavior, the researchers report in the current
issue of the Journal of the American Academy of Child and Adolescent
Psychiatry.
Also, the children's reports of shyness were associated with an increased
risk of later social phobia. Parents' reports of their child's shyness or
attention problems also predicted later social phobia.
Parental and teacher reports predicted later depression and violent
behavior, in particular, but to a lesser degree than the children's
self-reports, study findings indicate."
May 17, 2004
Q
My sister has been a constant worrier. She copes poorly with
many things. I do not think she is depressed, but I do feel
she can be easily overwhelmed. Is there a way to predict
whether she will become depressed?"
A Yes, there is
a greater risk of depression among those with neurotic anxiety: "The effects
of stress and personality on risk of depression are not merely additive.
Instead, individuals who are highly neurotic are at much higher risk for
major depression after a threatening life event than are their less neurotic
counterparts.
And for all but the most minor stressors, the likelihood of depression is
similar for men and women.
The effects of neuroticism and stress were multiplicative, the authors
found. the impact of neuroticism on the risk for major depression is much
greater in those exposed to high levels of long-term contextual threat.
Women were at slightly higher risk than men only when the level of threat
was low, probably reflecting women's higher risk overall rather than
stressful events themselves.
In fact, on average, men are slightly more vulnerable to romantic breakup
and its effects on depression, which is contrary to the stereotype of men as
the more independent and more invulnerable member of the species."
Am J Psychiatry 2004;161:631-636.
May 10, 2004
Q "My
family doctor put me on Zoloft for my depression. I truly do
not feel all that better."
A
Studies indicate that: "Supportive psychotherapy combined with
antidepressant medication is more effective than pharmaceutical monotherapy
in treating depression, especially in more severe cases...One study of
patients with depression compared the outcomes of 167 patients who were
randomized to receive either combination psychotherapy and antidepressant
pharmacotherapy (n = 83) or pharmacotherapy alone (n = 84). Of the patients
in the combined therapy group, 72% experienced a remission of their
depression symptoms compared with 57% of patients in the monotherapy group.
In a separate study that focused on severe, recalcitrant depression, more
than 60% of patients on combined therapy experienced remission after six
months of treatment. In the treatment of patients with bipolar disorder,
family-focused psychotherapy reduced the risk of relapse from the typical
90% to 60%....Combined therapy particularly improves outcomes in patients
with severe depression and in those with chronic and recurrent
depression...We also see this in patients with bipolar mood disorders. These
studies show the cost-effectiveness of using psychotherapy in difficult
cases. It is unknown still whether the type of psychotherapy is important.
Although antidepressant therapy is effective, nonadherence
is endemic; and "medications don't replace a lifetime of maladaptive
learning." Conversely, skeptics about psychotherapy's benefits call it an
"elaborate placebo." Its limitations include poor quality control and
limited efficacy as a monotherapy for severe depression. In addition,
psychotherapy requires patient motivation and is often conducted for months
without an objective benefit. Brain imaging studies are helping us to show
the ways that psychotherapy improves functioning.
May 3, 2004
Q
"My 22 year old daughter
has been treated for irritable bowel syndrome since she was
a young teenager. She does not seem to respond to treatment.
Is there research on other things she could try?"
A
This may be helpful to her: "In patients with
refractory irritable bowel syndrome, hypnotherapy reduces the
hyperresponsiveness of the colon after eating. "Postprandial symptoms in
irritable bowel syndrome are common and related to an exaggerated motor and
sensory component of the gastrocolonic response. Hypnotherapy patients were
given suggestions in the hypnotic state directed at normalizing GI function,
and included imagery of "a river flowing smoothly, or a blocked river flow
that was cleared by the patient. Patients were encouraged to practice their
"hypnotic skills" at home between sessions.
Patients in the supportive group attended sessions on diet emphasizing "good
and bad food items," and on relaxation training.
"At baseline, both groups had similar fasting balloon volumes in the colon
and demonstrated reduced balloon volumes, indicating increased tone during
the lipid infusion, without significant group differences. After the
treatment period, the hypnotherapy patients but not the control patients
"failed to demonstrate a colonic tone response during the lipid perfusion."
Based on their findings in relation to specific sensations, the
investigators conclude that hypnotherapy reduces the sensory and motor
components of the gastrocolonic response in irritable bowel syndrome.
Psychosom Med 2004;66:233-238.
April 26, 2004
Q
"I take an antidepressant
at bedtime. My wife says that now I snore and it sounds like
sleep apnea. Could I have sleep apnea?"
A
There are many sleep centers that can determine that diagnosis, and your
first stop should be with your primary care physician.
"Patients
treated with an antihypertensive and/or antidepressant drug have an
increased likelihood of being diagnosed with obstructive sleep apnea... many
of the patients coming in for evaluation of sleep apnea are being treated
not only for hypertension but also for so-called depression. The tie between
antihypertensive and antidepressant medication and OSA is "predictable,"
researchers note; "however the magnitude of this relationship was striking
and not anticipated, particularly in the young, in whom the frequency of
sleep apnea is low."
When you have patient who is fatigued, hypertensive, and on something for
hypertension and depression, "no matter what their age, you ought to think
of the possibility of sleep apnea regardless of their body type. What most
physicians don't realize is that not all patients with sleep apnea are fat
50-year-old guys. You may have a young thin female."
'Many times hypertension, depression, and fatigue resolve once you get them
treated correctly for their sleep apnea."
Chest 2004;125:1279-1285.
April 19, 2004
Q
"My dad tells me that my
mother was depressed the whole time she was pregnant with
me. I have heard of depression after childbirth but not
before. Is this common?"
A
The following may be helpful to you. "Results of a review of
studies involving more than 19,000 patients suggest that rates of depression
during pregnancy are high. This might be especially true during the second
and third trimesters.
Pooled results indicated that the prevalence of depression was 7.4% in the
first trimester, 12.8% in the second and 12.0% in the third.
Overall rates did not differ significantly across trimesters. However, the
team points out that the lower rate of depression in the first trimester,
"must be interpreted with caution," because few studies were available for
this period.
Altogether, in light of the "substantial" rates of depression, the
investigators conclude that "clinical and economic studies to estimate
maternal and fetal consequences are needed."
Obstet Gynecol 2004;103:698-709.
April 12, 2004
Q "I
am trying to quit smoking. The hardest time is after I have
a meal, but I was wondering if I should avoid going to bars
while I am trying to quit."
A Consider
this: alcohol "synergistically enhances nicotine's stimulant and calming
characteristics, as well as the...effects on smoking satisfaction and relief
of craving for tobacco."
"The behavioral link between smoking and alcohol use is highlighted by the
three-fold higher rate of cigarette smoking in alcoholic patients and the
10-fold higher prevalence of alcoholism in smokers versus nonsmokers
...Although smokers do not enjoy nicotine-free cigarettes as much, if they
comply with treatment, their craving tends to be extinguished over time as
does the potency of triggers to relapse....Donepezil...has a beneficial
effect on the function of frontal lobes ( and perhaps) that the drug can
provide the benefit that smokers seek from nicotine.
Nicotine Tob Res, February/March 2004.
April 5, 2004
Q "I
have read that my baby can be harmed if I am depressed after
delivery. If there any way to know whether I will become
depressed after the baby is born, and are there ways to
treat it or prevent it?"
A You may be
interested in this article: "Light therapy is helpful for antepartum depression, according to the results of a randomized pilot study.
"Bright light therapy was shown to be a promising treatment for depression during pregnancy. "Antepartum
depression is the strongest predictor of postpartum depression, which
further compromises the child's neurodevelopment and increases the risk for
early-onset depression and substance abuse." Successful treatment with
bright light was associated with phase advances of the melatonin rhythm, as
reflected in salivary melatonin measurements.
"These findings provide additional evidence for an active effect of bright light therapy for antepartum depression."
"Dosing of light is flexible and can be changed daily if untoward effects
such as hypomania occur, which enhances the clinical safety of this
intervention."
J Clin Psychiatry. 2004;65:421-425
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