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September 17, 2001
Q
"Based upon this Attack Upon
America, what is currently held to be the probable psychological
impact upon our society."
A
Psychologists said
survivors of the catastrophe and relatives of those killed in the
disaster would never be emotionally the same again. For millions of
others who watched the carnage on television the harrowing images
will be imprinted forever in their memory.
"Personal security is going to be shaken and
everybody's perspective on human life is likely to be shifted by
it," said Dr. Leslie Carrick-Smith, a British psychologist and
trauma expert. "Nobody is really going to feel safe because those
towers were icons, symbols of world commerce and order. People
realize how vulnerable they are to whoever could actually do that,"
he said.
"It turns the world into a totally alien, dangerous place in
which we cannot predict what is going to happen," said Dr. Gerard Bailes, a
clinical and forensic psychologist in eastern England.
"The scale of this is bigger than anything anyone has ever
seen in a lifetime. What is so potentially psychologically damaging about it is
its unexpected nature," Dr. Carrick-Smith said. He described the co-ordination
of the attack as terrifying and said that although it has been compared to the
Japanese attack on Pearl Harbor, it was not the same as war.
"War is different because war can be almost foreseen and it is
between clearly defined nations," Dr. Carrick-Smith said. "The outbreak of war
is generally premeditated and one can see it unfold. This happened in seconds
without any warning and the psychological reaction of many people will be — if
that can happen in seconds what will happen next?"
The people who coordinated and executed the attack do not
operate by normal human values and their delusions are so intense it is
impossible to predict what they might do, Dr. Carrick-Smith said. "It is not
unrealistic to say that this can actually threaten world order in terms of
commerce and oil and in terms of the unknown repercussions," he added.
September 10, 2001
Q
"My husband is 42 years of age. He
smoked 2 packs of cigarettes per day and rarely exercised. His
father died of a heart attack at 45 years of age. My husband just
had a minor heart attack and cannot snap out of it. Reassurance does
not seem to help. He has nightmares and other symptoms. What is
going on?"
A
Some survivors of myocardial infarction are so distressed by the
experience that they meet diagnostic criteria for post-traumatic
stress disorder (PTSD), study results suggest.
As many as 10% of MI patients develop PTSD. The
disorder may cause patients to avoid taking medications prescribed
for secondary prevention because to do so reminds them of their
traumatic experience.
The results suggest that MI patients who experience
complications such as angina need attention not only because they are at higher
risk of death, but also because they are more likely to have PTSD, the
researchers comment.
Gen Hospital Psychiatry
2001;23:215-222.
September 3, 2001
Q
"One of the guys in the office is
an exercise nut. He says that if he does not exercise that he will
become depressed. I told him that there is no basis for that. Is
there research on exercise and deprssion?"
A
According to a
study in the July issue of Health Psychology, 14 female
college students getting just 10 minutes of moderate exercise
improved their mood and energy levels. The mental benefits continued
when they exercised for 20 minutes, as participants reported they
had better mental focus. No immediate benefit was seen when exercise
went on for more than 30 minutes.
Changes like these happen right after people
exercise, without even having to test for them. Even brief bouts of
mild exercise can increase perceived energy and decrease tension.
Research supports guidelines of accumulating 30 minutes of physical
activity throughout the day, as recommended by the CDC and the
American College of Sports Medicine.
It's important to remember that individuals of different age,
physical condition, and training level may differ in how they feel after varying
types and amounts of exercise.
One person may feel better after only five minutes of exercise
while another needs 15 minutes of exercise to reap a similar significant
psychological benefit. The same person may need different time periods doing the
same exercise on different days to bring about equivalent changes in mood
states.
This study involved only stationary biking and did not address
long-term psychological benefits of regular exercise.
August 27, 2001
Q "My
wife has Bipolar Type I Disorder. We have two daughters, and we are
both concerned that they will inherit the disease. Is there
literature on this, and what is current thinking?"
A
The children of parents with bipolar disorder may not have an
increased risk of developing symptoms of the disorder by early
adulthood, according to the results of a study in the September
issue of the Journal of the American Academy of Child and
Adolescent Psychiatry.
The study finding "casts doubt" on the assumption
that children of bipolar parents are at substantially
higher-than-normal risk of developing problems during adolescence,
according to researchers.
The investigators found that, according to mothers' reports,
the adolescents studied were slightly more likely than average to have mood
symptoms, with girls showing greater anxiety and depression and boys greater
aggression. The teens themselves, however, showed no clear tendency toward
psychiatric problems on questionnaires.
In fact, for some mental and behavioral problems, children of
bipolar parents showed a lower-than-normal prevalence, according to data
obtained from the teens and their teachers.
The researchers do, however, acknowledge some shortcomings in
their analysis--including the fact that they studied mainly families belonging
to a patients' association. Children whose parents were recruited from
outpatient clinics for the study showed a tendency toward more problems.
J Am Acad Child Adolesc Psychiatry
2001;40:1094-1102.
August 20, 2001
Q
"My father has always said that my
being depressed will kill me. He does not mean suicide but that
depression itself will kill me."
A
Depression appears to increase the risk of death from congestive
heart failure, but it remains unclear whether treating the
depression would improve longevity, according to a report published
in the August 14/27 issue of the Archives of Internal Medicine.
Patients with major depression had the highest
mortality rates. Patients with major depression were more than twice
as likely as nondepressed patients to die or to be readmitted within
3 months to 1 year after hospitalization, the investigators
emphasize.
Depression is common in patients with congestive heart failure
and may play a significant role in their short-term prognosis. Whether treatment
of depression can reduce mortality and readmissions is unknown.
Arch Intern Med
2001;161:1849-1856.
August 13, 2001
Q
"My sister has gone from one
relationship to another, abused in each of them. Our father was
abusive, and I wondered if there is any evidence that this is at
least part of the cause."
A
Women who were physically or
sexually abused as children have a substantially increased risk of
revictimisation in adulthood reported in the August 11th issue of
The Lancet.
Past research has shown an increased risk of
victimisation in adulthood for women who were physically and
sexually abused as children. However, this research concentrated on
sexual revictimisation and did not include data on other types of
abuse or on the prevalence of revictimisation.
Women who had unwanted sexual intercourse when
they were 16 years of age or younger had an increased risk of
domestic violence as adults.
In addition, women who had unwanted sexual
intercourse as children had an increased risk of rape as adults as
were those who had been severely beaten. Women who had been beaten
as children were also at increased risk for other traumatic events
as adults.
Lancet
2001;358:434,450-454.
August 6, 2001
Q
"I have a patient who was in an automobile accident 10 months
ago and now has anxiety symptoms not present a month ago. Is this
highly suspicious?"
A
Individuals who survive a motor
vehicle accident may experience new onset of certain disorders as
long as 1 year after the crash, study findings show.
One third of 773 individuals involved
in a road accident as a driver, bicycle rider or pedestrian were
experiencing some level of anxiety, depression, fear of travel or
post-traumatic stress disorder (PTSD) 3 to 12 months later. In some
patients, symptoms worsened or appeared for the first time about 3
months after the accident.
The findings, published in the August
issue of the American Journal of Psychiatry, point to
the need for early recognition and treatment of psychiatric problems
in accident survivors.
In most cases, symptoms surfaced
during the 3 months after the accident and persisted. After 1 year,
about half of the group reported phobic travel anxiety. Nearly 60%
reported general anxiety, and half were diagnosed with PTSD.
Men, who were more often the drivers,
were more likely than women to blame themselves for the accident.
Women were more likely to report emotional problems in the month
before the accident, and they reported more fear after the accident.
While the findings highlight the need
for doctors to watch for symptoms of certain disorders in accident
survivors, they should not be generalized. Data were obtained
through patient self-reports and that women and individuals older
than 30 were over-represented in the study.
Am J Psychiatry
2001;158:1231-1238.
July 30, 2001
Q
"In my children's school, it seems to me that most of the
financial resources are spent on containing and dealing with the
problem children with much less emphasis on the children who are
there to learn. Is that an accurate observation, or am I just one
more frustrated parent?"
A
Children and adolescents
with conduct disorder are likely to incur public service costs by 28
years of age that are much higher than those of unaffected children,
but parenting programs may help, according to the findings of two
studies published in the July 28th issue of the British
Medical Journal.
Individuals with childhood conduct
disorder incurred costs that were 10 and 3.5 times higher than those
of unaffected and conduct problem individuals. Crime accounted for
the greatest cost in all groups, followed by extra educational
needs, residential and foster care, state benefits and healthcare.
While low parental social class, low
reading age, and attending more than two primary schools did
independently increase societal costs, the presence of a conduct
disorder still predicted the greatest cost, the researchers state.
Parenting groups effectively reduce
serious antisocial behavior in children. Parenting programs might be
even more cost-effective, more pervasive in impact, and less
stigmatizing if they were offered as a preventive measure before
children were socially excluded and diagnosed as having oppositional
defiant disorder or conduct disorder."
BMJ 2001;323:191-198.
July 23, 2001
Q
"I am being treated for
depression, and I often feel alone if not humiliated by being this
way. My doctor tells me not to worry; that it is common. He also
tells me it is a disease. Do you believe that?"
A
More likely a disorder not a
disease. A survey
conducted by the National Mental Health Association (NMHA) shows
that most Americans now believe that depression is a disease as
opposed to a state of mind.
In January, the NMHA conducted a
telephone survey of 500 adults aged 21 to 70 who were currently
being treated for depression, 300 healthcare providers who treat
people with depression, and 800 other adults over the age of 18.
According to the NMHA, in 1991 only
38% of people polled indicated that depression is a disease. In the
current survey, that figure was 55%.
Another key finding was that
three-quarters of those with depression report that "they will
probably need some kind of treatment throughout the rest of their
lives."
Many being treated for depression
have found that the treatment helps them control their illness.
Indeed, 66% of those surveyed noted that "continuing with their
treatment 'would be very effective' in preventing a return of
symptoms and 62% of those currently using therapy rate it as 'very
effective,' " the NMHA reports.
July 16, 2001
Q
"My sister has been diagnosed with obsessive compulsive
disorder, and the psychologist blames our parents. What is current
thinking?"
A
Obsessive compulsive
disorder (OCD) can be a disabling condition, affecting about one out
of every 25 people in the United States at some point in their
lives. For those who suffer from OCD, concern about accuracy may
turn into constant fact checking. Cleanliness leads to constant hand
washing and skin eroded by detergent chemicals.
It was once widely believed that OCD
was caused by a dysfunctional upbringing. Patients with OCD, in
fact, were one of the major models on which much of psychoanalytic
theory was based. Ironically, we now know that childhood upbringing
plays little, if any, part in obsessive-compulsive disorder. OCD is
now known as one of the most clearly defined examples of a mental
illness caused by a specific brain dysfunction.
Compared to many other diseases like
schizophrenia and depression, OCD has one of the highest rates of
onset in childhood and adolescence. About 50% probably develope the
disorder before adulthood. There may be a correlation between OCD
and strep infection.
July 9, 2001
Q
"My wife has stopped smoking, but she seems awfully
depressed...not just having a hard time but really depressed. Can
this be caused by quitting?"
A
Smokers with a history of
depression who kick the habit are likely to go into major depression
within 6 months, according to a new study in the June 16 edition of The
Lancet.
The findings confirm a
long-held and distressing suspicion about the relationship between
smoking and depression: Smoking may be an especially toxic way by
which some depressed individuals self-medicate their symptoms.
The sites in the brain
where nicotine may be acting to dampen the effects of depression
could be exploited to produce drugs that have a similar effect --
without the harmful effects of smoking.
In the study, the people
who continued to smoke got depressed 5% of the time, but the people
who stopped smoking got depressed over 30% of the time. People with
a history of depression were much more likely to smoke than those
who did not.
If people with a history
of depression try to quit, they are going to have a harder time.
They are in a tough place -- they are quitting smoking to improve
their health but at greater risk for depression.
July 2, 2001
Q
"My husband (45) has a
serious sleep problem. He will not see anyone for it and says that
he'll just nap when he gets home from work and will be fine. I
wonder if his sleep problem could effect his heart or
something."
A
People who do not get
enough sleep on a regular basis may become less sensitive to
insulin.
In fact, chronic sleep deprivation
— 6.5 hours or less of sleep a night — had the same effect on
insulin resistance as aging.
Just like poor diet, sedentary
lifestyle, chronic stress and aging, sleep loss is a...risk factor
for type 2 diabetes.
In a study at the University of
Chicago, healthy adults who averaged 316 minutes of sleep a night
— about 5.2 hours — over 8 consecutive nights secreted 50% more
insulin than those who averaged 477 minutes of sleep a night, or
about 8 hours. As a result, short sleepers were 40% less sensitive
to insulin.
The researchers suggest that sleep
deprivation, which is becoming commonplace in industrialized
countries, may play a role in the current epidemic of type 2
diabetes. There is a steady decline in the number of hours Americans
sleep each night. In 1975, the average American slept 7.5 hours,
down from 9 hours in 1910. Today, adults sleep about 7 hours a
night.
September 24, 2001
Q "Is
there not evidence that behavioral psychotherapies can cure chronic
fatigue syndrome?"
A
The first systematic review of all therapeutic interventions that
have been evaluated for chronic fatigue syndrome (CFS) shows mixed
results.
While behavioral and graded exercise-based
therapies have shown promising results, there is insufficient or
inconclusive data to judge the effectiveness of most other
therapies, including drug treatments, supplements and
complementary/alternative approaches.
But as noted, the behavioral psychotherapies have shown promising results.
JAMA
2001;286:1360-1368,1378-1379 .
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