Antidepressants may play a key role in alleviating painful conditions like osteoarthritis and may result in fewer side effects than traditionally prescribed drugs, such as anti-inflammatories and opioids, according to new research.  Researchers at New York Medical College analyzed the latest clinical evidence on duloxetine (Cymbalta), an antidepressant that received FDA approval in 2010 for use with chronic musculoskeletal pain, including osteoarthritis.

“It is not uncommon to treat osteoarthritis with a combination of drugs that work in different ways,” said Leslie Citrome, M.D., clinical professor of psychiatry and behavioral sciences. “Our review supports this approach and confirms that antidepressants are not just for depression and can play a key role in relieving this painful condition.”  The reseachers looked at studies exploring the effects of Cymbalta (duloxetine) on its own or in combination with non-steroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen) — including the two double-blind, placebo-controlled clinical trials that formed the basis of FDA approval for duloxetine for the treatment of chronic pain associated with osteoarthritis.

Study results were analyzed using number needed to treat (NNT) and number needed to harm (NNH). These quantify how many patients need to be treated with one intervention versus another before encountering one additional patient who experiences a desired outcome (NNT) or undesired disadvantage, such as a side effect (NNH), researchers said. A smaller number indicates greater advantages for NNT and greater disadvantages for NNH.  “Applying these simple methods to often complex research gives us a real indication of whether a drug will benefit or harm our patients, which is what we as clinicians are most interested in,” Citrome said.

When duloxetine was compared with a placebo containing no active ingredients, using data from the two FDA approval studies, the NNT was six. This means that six patients would need to be treated with duloxetine instead of receiving the placebo before encountering one additional patient experiencing an improvement in pain using a composite measure that brings together a number of indicators of efficacy. Such a low NNT makes a compelling case for this treatment approach, he said.

The authors said that this finding, over 13 weeks, compared favorably with other studies of NSAIDs — the NNT was five for etodolac after four weeks and four for tenoxicam after eight weeks.  When side effects were taken into account, this showed that when duloxetine was used on its own for 13 weeks it provided a number of advantages over NSAIDs, which can lead to gastrointestinal bleeding, and opiates such as morphine, which can cause constipation.

The most common side effects of duloxetine — nausea, fatigue and constipation — were small when compared to the placebo, resulting in NNHs of 16, 17 and 19 respectively, the researcher notes. This means, for example, that 16 patients would need to be treated with duloxetine instead of receiving the placebo before encountering one additional patient experiencing nausea.  The studies used to gain FDA approval also showed that pain reduction using duloxetine on its own was not dependent on an improvement in depressive symptoms.

“Although the use of duloxetine as a monotherapy for pain has been approved by the regulatory agencies, it is quite common for patients to receive a combination of drugs, and NSAIDs are the most frequently prescribed drugs for the pain associated with osteoarthritis,” said co-author Amy Weiss-Citrome, M.D., a specialist in physical medicine and rehabilitation.  For that reason, the authors also examined the findings of a recent study that showed the potential synergy of duloxetine and NSAIDs.

The study, a 10-week double-blind trial of 524 patients with osteoarthritis of the knee, found that those who took a combination of duloxetine and NSAIDs reported greater pain reductions than the control group who took a NSAID with a placebo.  The NNT for the outcome of substantial improvement in pain with combination treatment versus NSAIDs alone was six, underlining the benefits of this approach, the said.

“We believe that our analysis of these studies demonstrate that clinicians managing patients suffering from osteoarthritis should also consider prescribing adjunctive antidepressants that can effectively impact on central pain pathways,” said Citrome.

Nothing takes the wind out of someone’s sails like getting a divorce. Even if your disposition prior to your split was happy-go-lucky — even optimistic — and you “wanted” the divorce, you may be surprised at how low and depressed you’ve been feeling.

Take heart, this is a common occurrence for the majority of divorced folks.  Yesterday I had a conversation with a newly single dad. He’s been officially divorced for about eighteen months and said he is just now feeling better. My own divorce left me in a puddle on the floor for much longer than I would have liked, and I was among the “happily divorcing” set. I thought for sure I would effortlessly get divorced and on with my life — ready, willing and able to continue to be successful and even find a new relationship.  Not so fast! It takes thought and effort to get your mojo back, so here are my top 3 strategies for feeling better faster after divorce:

1. Give yourself a minute to heal and establish a new normal. You’re used to being in a relationship, waking up next to someone, having someone to hang out with on weekends and holidays. The end of a relationship requires healing, and healing is not instantaneous (darn it!). Find yourself a confidant and a great therapist, and engage fully in your healing process. Now is the time to discover and rediscover what you want to do, who you want in your life, and exactly how you want to spend your time.

2. Begin to do new things. Chances are you’ve eaten at the same restaurant more than a hundred times, gone to yoga three times a week, and spent long holiday weekends in Cabo. Dust off your inner third-grader and learn how to speak a new language, visit a new country, or learn how to line dance. The truth is, emotion is created by motion and the only emotions you’re going to conjure sitting on your couch are those that require Kleenex. Grab your best friend (or find a new one) and try Pilates or spin, schedule a cruise or tour to Tuscany, or go back to school. Get yourself out in the world, doing things you find enjoyable, and soon you will feel better.

3. Stop telling your old story; design a new future vision and talk about that! It’s tempting to tell and retell your end-of-relationship story. But let me ask you this: Does it make you feel better to tell that story? I’m going to guess the answer is no. In order to feel better, you’ve got to get excited about something, and that something is your future — the future you get to decide in advance and get busy creating. Block out a few hours, pencil in hand (or crack open your computer), and describe how you would like your life to be right now and even five years from now. You can’t focus on what happened and what you want to happen at the same time.

Remember this: Your best days are ahead of you, and the most magical of moments are yours for the making and the taking.

The idea that your sex drive goes AWOL in old age is one big myth: In truth, sex can get even more exciting and stimulating with age. How? You can kiss some of the stresses of your younger years goodbye and focus on rediscovering the sizzle with your spouse.

While age presents some people with sexual challenges (such as erectile dysfunction or decreased libido), these five steps can help all seniors intensify their love life.

1. Slow    things down a notch.It may take you and your partner a    little longer to become aroused than it used to. “Staying relaxed and having a    flexible attitude is a big help,” says Bob G. Knight, PhD, the Merle H. Bensinger professor of gerontology and    professor of psychology at the Andrus Gerontology Center at the University of    Southern California in Los Angeles, and director of the Tingstad Older Adult    Counseling Center.Make    more time for intimacy and be prepared to approach sex differently. What once    turned you and your partner on may not have the same effect anymore. Take the    time to experiment your way to better sex.    “I think of this as a gift to women,” says Joan Price, author of Better    Than I Ever Expected: Straight Talk about Sex After Sixty and Naked    at Our Age: Talking Out Loud about Senior Sex. “Men are finally    interested in foreplay.”

   Just    spending time touching is a great warm-up for senior sex. Price, 67, began    writing about senior sex 10 years ago when she fell in love with a man and, as    she describes it, “had great, exhilarating, spicy sex, but it wasn’t like in    our twenties, not at all.” She then realized that the overwhelming cultural    belief was that senior sex would be dull and painful at best. It’s neither of    those, she says, but it is different, in large part because of the    physiological changes that come with aging.

2. Chat    about your body’s changes. Whether you need to open up about your    changing needs to a lifelong partner or get to know a new one, communication is    key. “Talking before, during, and after can lead to more enjoyable experiences    and avoid misunderstanding and anxiety,” says Knight. For particularly    difficult conversations, such as those related to taking medication for    erectile dysfunction or addressing a need to overcome low libido,    he advises picking a time when you feel close and relaxed, but not when sex is    imminent. Being honest about what’s going on and what you hope will be going on    — as difficult as speaking these words might be — is the    best approach, he says.
3. Experiment    with new positions and toys. Spicy solutions to senior sex problems    are guaranteed to be interesting topics of conversation. Just as you may need    more time to become aroused, you might also want to try something new. Using sex toys(such as    vibrators) and practical aids, such as lubricants, can up the wow factor.If you    find that sex aids top the list of difficult things to talk about, keep this in    mind: “If we have slow arousal and arthritic wrists, why not just turn on a tool    that does the job really well because that’s what it’s designed for? If we need    a little assist, that’s okay,” says Jones. Other new moves may be as simple as    a change of position or the addition of some pillows to support achy bones.
4. Explore    on your own. Don’t have a partner? Masturbation    has been shown to improve both physical and emotional health, so don’t let    being alone keep you from getting pleasure. “When suitable partners are not    available, self-stimulation can be useful and healthy,” says Knight. Take time    to discover what pleases you, and be creative — it may even lead to    better sex with your partner as you learn about what works best for you. This    may also be a good way to try out sex toys before you bring them up in    conversation.
5. Stay    healthy.    Your body may be changing, but you can improve how it works and feels by making    healthy diet and exercise choices. These choices, in turn, can lead to better    sex by maintaining muscle strength and aerobic capacity.One    important element of staying healthy? Practice safe sex. Even though you don’t    have to worry about unwanted pregnancy, age does not protect men or women from sexually    transmitted diseases. Plan on using condoms for sexual    intercourse if you and your partner are not in a long-term, monogamous    relationship.

March 30, 2012 –By Rita  Rubin WebMD Health News.      Snorting, gasping, or short interruptions in breathing during sleep may be linked to depression symptoms, new research shows.  The more frequently people snort, gasp, or stop breathing for short periods of time while asleep, the more likely they are to have symptoms of depression, according to a government study of nearly 10,000 adults released today.  Snoring, however, was not linked to depression symptoms in the study, which appears in the April edition of the journal Sleep.  “Sleep is essential, and healthy sleep should be as important as healthy nutrition, physical activity, and smoking cessation in promoting overall health,” the researchers write.

Sleep and Depression

“Sleep-disordered breathing” — the snorts, gasps, and short pauses in breathing that characterize obstructive sleep apnea — has been linked with depression in previous research.  But those studies typically were much smaller and focused on patients who had come into sleep labs and been diagnosed with sleep apnea, says Anne Wheaton, PhD, an epidemiologist at the CDC’s National Center for Chronic Disease Prevention and Health Promotion.

Wheaton’s study is the first to look at the connection between sleep-disordered breathing and depression in a nationally representative sample of U.S. adults. They took part in the National Health and Nutrition Examination Survey, or NHANES, from 2005 to 2008.  For NHANES, people reported how frequently they snored and snorted, gasped, or briefly stopped breathing while asleep. They also completed a short questionnaire about depression symptoms and had their height and weight measured.

The results:

• Six percent of men and 3% of women said a doctor had diagnosed them with obstructive sleep apnea.

• Seven percent of men and 4% of women said they snorted/stopped breathing at least five nights a week.

• Men and women who said they snorted/stopped breathing at least five nights per week were three times more likely to show signs of major depression, compared to those who said they never snorted or stopped breathing during sleep. That takes into consideration other factors, such as weight, age, sex, and race.

Possible explanations for the link between sleep-disordered breathing and depression include diminished oxygen to the brain and interrupted sleep, Wheaton says.  More research is needed to determine whether treating apnea patients for depression would improve their quality of life and whether treating depressed patients for sleep-disordered breathing would reduce their need for antidepressants, Wheaton says.  “Many sleep specialists do routinely screen for depression,” says sleep specialist Amy Aronsky, DO, medical director of a sleep facility in Longview, Wash. Depression might result from untreated sleep disorders, Aronsky says, and poor-quality sleep might worsen depression symptoms.

Which Comes First?

A key question is whether sleep apnea actually causes depression. The new study doesn’t settle that.

Answering that question would mean following people for years, an expensive proposition, notes Paul Macey, PhD, assistant professor in-residence at the UCLA School of Nursing and Brain Research Institute. Macey was not involved with Wheaton’s study. Last year, he says, he began asking patients to draw up a timeline of their symptoms. He expected sleep apnea would come first, followed by the depression.  “That hasn’t been the case,” Macey says, cautioning that the evidence “is still anecdotal at this point.”

Very recently my dad, one of eight children, passed away. Losing my dad was not easy, but it did give me the chance to learn a lot about where I and my son’s ADHD came from.

I knew very little about his life growing up, and he never talked with me about his past. All I knew was that he was a very rebellious young adult that had never graduated high school, but somehow managed to land a very comfortable salary and a stable job.  This put an image in my head of what his family must had been like – but it actually turned out to be very different.  The tragedy of my dad’s death brought people back into my life that I had very little contact with over the years. Turns out, their family was very close, and his parents were loving and nurturing people – a lot how I see the family I’m raising now.  Besides that, the main thing I took away was that there is a lot of extremely intelligent and ADHD diagnosed people in my family.

• So, I started to wonder – is ADHD genetic?

At my dad’s funeral, I met most of his siblings – a few, I had met before but I was far too young to remember. From what I gathered, everyone had a link to ADHD.   It seemed to be limited to the males in the family though, which wasn’t at all surprising: ADHD is far more common in boys. I hope that’s true anyway because I’ve got a daughter that I’m hoping it skips!

My family stories all boiled down to the same outline. One uncle was described as being “an overwhelming force to be reckoned with” as a youngster, although when I glanced over at him then, he was talking to my son about trains and had him totally engaged. He seemed like a very interesting and creative person, but not at all scattered or hyper. My relatives then explained that he has a very high IQ. That didn’t surprise me either – I suspect that most ADHD people have a high intelligence capacity.

This story played out almost the exact same way from the different aunts and uncles that spoke with me about their experiences. Their children were just like my son Kennedy and got in a whole lot of trouble at school. The doctors offered no help except medication. Some followed very strict diets that seem to lessen symptoms and make them more manageable. No matter what, they all got through it as a family.

• Look at that, maybe they do grow out of it…

After discovering the strong lineage of ADHD in my family, I was given a fresh prospective on it all. This new found discovery, of what apparently runs through my own genes, taught me that it is possible to pull through it.

Through every relative that approached me, I was given hope. They all had the same story about a brother, son, grandchild or someone that was a complete terror when they were young. However, the stories seemed to all end the same. Most of them are college graduates, and many of them are very successful business owners.

They still deal with symptoms and struggle with concentration as adults, but ADHD obviously hasn’t held them back at all!

By Linda Lewis Griffith .   Are you making yourself sick by thinking you’re sick? Some simple advice can help you to break this cycle of unfounded anxiety.  It’s important to take care of your health. Regular visits to the doctor address issues as they crop up. Routine screenings can catch problems while they’re treatable and small.  But some folks get carried away. They fret needlessly about diseases they don’t have. They fear they’re suffering from a fatal illness, even though tests prove there’s nothing wrong.

By Rick Nauert PhDSenior News Editor
Researchers believe they have gained key insights on the development and progression of Alzheimer’s disease.  The findings could lead to the development of antibiotic treatments that could prevent the onset of the devastating illness.

Investigators have learned that a key protein, called a tau-protein, transforms from being a critical component of normal brain function to a sinister malformed villain that destroys brain cells.  Researchers at Beth Israel Deaconess Medical Center (BIDMC) developed the technology that distinguishes the two tau isoforms — one healthy and one disease-causing. Their research shows that only the disease-causing isoform is found in the neurons of Alzheimer’s patients and is exhibited at a very early stage of disease.

The new research, described in the journal Cell, provides tantalizing clues that the disease-causing tau element may be identified and then treated with antibiotics or vaccines at the very early stage of Alzheimer’s disease, reducing or even preventing, the onset of the devastating illness.  “Since Alzheimer’s disease takes at least a decade to develop, the major challenge to halt memory loss is to identify the initial period when the tau protein is transformed from ‘good guy’ to ‘bad guy,’” said co-senior author Kun Ping Lu, M.D., Ph.D.

“By developing an innovative approach to making antibodies, we have uncovered a new strategy to specifically remove disease-causing tau, while leaving healthy tau intact to carry out its important responsibilities.”  The most common form of dementia in older individuals, Alzheimer’s disease currently affects 5.4 million Americans and 30 million people worldwide.

Baby boomer aging and a longer life expectancy will increase the number of victims with some estimates suggesting 120 million people with Alzheimer’s worldwide by 2050. The expected cost of caring for this cohort is more than $1 trillion in the U.S. alone.  “An immunization strategy that targets only the disease-causing twisted tau might enable diagnosis and treatment of memory loss at an early stage, when therapies are most likely to be effective,” said Lu, comparing the situation to that of hypertension.

“Early diagnosis of hypertension can lead to effective treatment to prevent complications,” he said. “But if high blood pressure goes undiagnosed, it can result in a stroke, at which point treatment is limited and extremely expensive.  “Similarly, early diagnosis of Alzheimer’s patients before the onset of severe memory loss could offer doctors a much better chance of halting or even preventing this costly and devastating disease.”

By Sharon Kirkey, Postmedia NewsMarch 29, 2012

Bilingualism helps protect the aging brain and may even postpone signs of dementia, a new review of recent studies indicates.  The paper by Canadian researchers, published Thursday, suggests that bilingual people have higher cognitive reserves as they get older.

Higher cognitive reserve is associated with a lower risk of Alzheimer’s and other memory-destroying dementias.  More than half the world’s population is bilingual, the researchers write in the journal Trends in Cognitive Sciences. In the United States and Canada, about 20 per cent of the population speaks a language other than English at home.

Lead author and psychologist Ellen Bialystok, of Toronto’s York University, had already begun accumulating evidence that the bilingual advantages seen in children could also be found in healthy adults. In a 2004 study, her team reported that bilingual adults, young and old, performed better than monolinguals on “conflict tasks” – situations where people need to ignore distracting stimuli to perform properly. (Think of driving on a busy highway).

In hundreds of interviews with reporters and science writers, Bialystok said, she kept being asked one question: What about dementia?

In a study published in 2007 involving about 200 Alzheimer’s patients, half of whom were lifelong bilinguals, her team found that the bilingual patients had been diagnosed 4 1/2 years later on in the disease than people who spoke only one language, a difference Bialystock calls “huge.”  Others have recently shown that bilingual Alzheimer’s patents are better able to cope with the disease and can function longer without showing symptoms, even when CT scans of their brains show more advanced “pathology” or disease.

It has to do with cognitive reserve, Bialystok says – “a building up of resilience that comes from certain experience that allows you to cope.

“If what you have to cope with is cognitive impairment from nasty things like Alzheimer’s disease, the finding is that (bilinguals) can appear to function for a longer time than they otherwise would,” she said. “Cognitive reserve is an extra resource that enables you to keep functioning.”  It’s not exactly clear why. But one theory is that managing two different languages boosts brain regions that are critical for general attention and cognitive control.

“We know that if you know two languages, and that there are two languages you could be speaking at any time, then both of those languages are always active – they’re always kind of `available’ in your mind,” she said.  “That means that every time you want to say something or understand something or write something, there’s potential interference from the other language.”

When that happens, the brain’s executive-control system kicks in to manage the conflict between languages.  The executive-control system is the basis for our ability to multi-task and to stay focused on what’s relevant and avoid distraction.

In bilinguals, that brain network gets “massive practice,” said Bialystok, a Distinguished Research Professor at York.  The new science into aging bilingual brains has implications for children. “For parents, one important implication is not to be afraid of languages. You’re not damaging your children if you give them a variety of language experiences,” Bialystok said.

While women experience eating disorders considerably more  often than men, eating disorder stats show more and more men are being  diagnosed with anorexia, bulimia and binge eating disorder.

• In their lifetime, an estimated 0.6% of the  adult population in the U.S. will suffer from anorexia, 1% from bulimia and  2.8% from binge eating disorder
• One in 200 American women suffers from anorexia
• Two to three in 100 American women suffers from  bulimia
• An estimated 10%-15% of people with anorexia or  bulimia are males
• By their first year of college, 4.5%-18% of  women and 0.4% of men have a history of bulimia
• 35% of “normal dieters” progress to  pathological dieting. Of those, 20%-25% progress to partial or full-syndrome  eating disorders.
• Eating disorders are seen in equal amounts across  races

Eating disorder statistics show women are much more likely than men  to develop an eating disorder. These numbers reflect  the lifetime likelihood of an eating disorder for women vs. men.

• Women are three times as likely to experience  anorexia (0.9% of women vs. 0.3% of men)
• Women are three times as likely to experience bulimia  (1.5% of women vs. 0.5% of men)
• Women are 75% more likely to have a binge eating  disorder (3.5% of women vs. 2% of men)

Eating Disorder Stats Reveal Dangers of Eating Disorders
Eating disorders are mental illnesses with a shocking risk  of death. Anorexia has the highest mortality rate of any mental illness. Eating disorder statistics show that 5%-10% of anorexics die within 10  years of contracting the disease and 18%-20% of anorexics will be dead after 20  years.

Statistics on recovery from eating disorders are perhaps even more  frightening; one eating disorder statistic indicates only 30%-40% of anorexics  ever fully recovering. Here are more statistics:

• Only 1 in 10 people with an eating disorder  receive treatment
• The mortality rate among people with anorexia  has been estimated at 0.56% per year, or approximately 5.6% per decade
• The death rate of anorexia is about 12 times  higher than the annual death rate due to all causes of death among females ages  15-24 in the general population
• Without treatment, up to 20% of people with  serious eating disorders die. With treatment, the mortality rate falls to 2%-3%.

article references

Sources: Eating disorder statistics provided by the United States  National Institute on Mental Health, the South Carolina Department of Mental  Health and the Mirasol Eating Disorder Recovery Center.

By SheSpeaks | Parenting

Handing over the car keys is worrisome for any parent of a new teenage driver. But when you add cognitive conditions such as attention deficit hyperactivity disorder (ADHD) or Asperger syndrome, the worries and risks escalate. A recent New York Timesreport highlights the unique challenges teens with ADHD face when learning to drive.

Since driving takes a great amount of focus and patience, it would make sense that teens with the hyperactive disorder would have a more difficult time honing this skill.

A recent study from the Medical University of South Carolina and Daniel J. Cox of the University of Virginia Health System finds that drivers with ADHD are up to four times more likely to have an accident as those without the condition. And surprisingly, young adults with the ADHD are even more likely to get into a wreck than a legally drunk adult.

Researchers suggest parents encourage their teens with ADHD to wait until they are a little older to begin driving. And when they do begin to learn, be patient because it may take them longer until they are fully ready to be safe on the road.

Senior investigator at the National Institute for Child Health and Human Development, Dr. Bruce Simons-Morton, explains why he believes it is best for teens with cognitive conditions to hold off on driving until they are older. Dr. Simons-Morton says, “If I were the parent of an ADHD or other special-needs kid, my goal would be to delay licensing. They mature, they accommodate to their deficits and they’re more likely to take medication.”

Should parents use different tactics to discipline a child with ADHD? Surprisingly, the answer is no, says Steven L. Pastyrnak, PhD, division chief of pediatric psychology at the Helen DeVos Children’s Hospital in Michigan.

“ADHD is a challenge, not necessarily an excuse for kids,” he says. “We need to be more aware of how the ADHD impacts their ability to listen, follow through on tasks, and control their impulses. However, having ADHD does not take away the expectation that they will improve in these areas.”

That doesn’t mean that parents might not have to be a little more flexible in their expectations of a child with ADHD. “Kids with ADHD are more likely to struggle with what they hear and process in the moment and what they remember even a few moments later,” Pastyrnak says. “These are the types of kids who can remember details of a family vacation from many years ago but forget to pick up their socks just a few seconds after they were told. Broken plates, hungry pets, and lost homework is common and even to be expected with kids (or adults) with ADHD.”

So parents shouldn’t necessarily use different approaches with a child who has ADHD. Instead, they should just understand that a disciplinary lesson that may take a child who doesn’t have ADHD 10 repetitions to learn may take 20, or 30, or 50 for a child who has ADHD.

“Where discipline also tends to differ is in the frequency and consistency needed for kids with ADHD,” Pastyrnak says. “I sometimes tell parents that parenting a child with ADHD is like parenting a child times five.”

Does Time-out Work?

Murphy eventually gave up on using time-outs with Josh. “I’d put him down, he’d get up,” she says. “I’d put him down again, he’d get up again — over and over. I’d get angry and then we were battling over putting him in time-out, and neither one of us could remember why he’d gone in time-out in the first place.”

Carla Counts Allan, PhD, director of psychological services at the ADHD Specialty Clinic at Children’s Mercy Hospitals and Clinics in Kansas City, Mo., outlines a time-out strategy that she says works effectively with all kids — whether or not they have ADHD — when used consistently.

• Contrast time-out with time-in. That means that if you put your child in time-out for hitting his sister, you should have been praising him earlier for playing well with his sister, and should praise him afterward for having a good attitude. “If there isn’t a big difference between time-out and time-in, kids don’t understand the consequences,” Allan says.
• Keep time-outs brief and consistent with the infraction. “Long time-outs can start a battle of wills,” she says. “For younger children, 1-2 minutes is plenty. A minute per year of age is more an upper limit for time-out, but for preschoolers, sometimes a 30-second or one-minute time-out is plenty if they show me quiet feet, quiet hands, and quiet mouth.”
• Remain calm. If you tell the child to go to time-out and he ignores you, add one minute to his time-out. If he doesn’t go again, add another minute. But if he ignores you a third time, don’t pick him up and drag him to time-out — that just escalates things. “Instead, impose a consequence that means a lot, such as no video games for the rest of the day,” Allan says. “Deliver that consequence calmly and don’t talk about it further. Even if he says, ‘I’ll listen, I’ll go into time-out now,’ don’t give in then!”
• Practice time-outs. Ask your child to pretend that he hit his sister, and that he is sent to time-out. “‘If you go willingly when I tell you to, you earn a point on a behavior chart and earn privileges,'” she says. “Have them practice going to time-out without putting up a fight.”

Practice Makes a Little Closer to Perfect

Practicing time-outs goes along with another general discipline strategy for kids with ADHD (or any child): teaching them the skills they need to succeed before they have a problem.

For example, all kids need some sort of a schedule or guidance to help them keep up with chores, homework, and other expectations. Kids with ADHD, Pastyrnak says, can’t be expected to “just get it” from verbal instructions. Instead, they often respond better to a visual schedule that they can follow.

Reward systems work well for kids with ADHD, but they too may need to be tweaked slightly. “For example, one expectation might be to play appropriately with his sister,” says Mark Bertin, MD, a developmental pediatrician and assistant professor of pediatrics at New York Medical College and the author of The Family ADHD Solution: A Scientific Approach to Maximizing Your Child’s Attention and Minimizing Parental Stress.

“It’s probably not realistic to set that expectation for an entire day,” Bertin says. “If they mess up in the morning, you’ve lost the whole day.”

Instead, break the day up into thirds and grant points for good behavior in the morning, the afternoon, and the evening.

Adjust Expectations

You can’t change everything at once in children with ADHD, Bertin says.

“Choose a few big things that you want to work on, and put other things aside for now. Don’t wrestle as much with the stuff you’re not working on yet.”

That was something Murphy learned. “You need to pick your battles — but when you do pick one, stay with it and be consistent.”

She developed a four-point strategy she called CARE, which echoes much of what ADHD experts say about disciplining such children:

1. Clear away distractions and things that cause inappropriate behaviors.

2. Allow your child to choose an appropriate activity.

3. Redirect into a more appropriate activity when things are not running smoothly. Offer them something they can do, rather than just telling them what they can’t do. For instance, “You can’t hit your sister, but you can whack these pillows.”

4. Exit. When things are out of hand and you know you can’t do anything but fight an uphill battle — get out. Go to the park or to an indoor play center. Don’t fight with your children.

It seemed to work with Josh, who’s now a successful and happy 25-year-old. “I focus on positive parenting,” says Murphy, who wrote a book, Gifted With ADD, about what she’s learned. “If he knows you’re on his side most of the time, when you pick the battle, he knows there’s a problem.”

Today, we’re posting information from Dr. Rebecca Landa, director of the Center for Autism and Related Disorders at the Kennedy Krieger Institute in Baltimore, Md., who says that parents need to be empowered to identify the warning signs of ASD and other communication delays:

Though autism is often not diagnosed until the age of three, some children begin to show signs of developmental delay before they turn a year old. While not all infants and toddlers with delays will develop autism spectrum disorders (ASD), experts point to early detection of these signs as key to capitalizing on early diagnosis and intervention, which is believed to improve developmental outcomes.

“We want to encourage parents to become good observers of their children’s development so that they can see the earliest indicators of delays in a baby’s communication, social and motor skills,” says Dr. Landa, who also cautions that some children who develop ASD don’t show signs until after the second birthday or regress after appearing to develop typically.

For the past decade, Dr. Landa has followed infant siblings of children with autism to identify red flags of the disorder in their earliest form. Her research has shown that diagnosis is possible in some children as young as 14 months and sparked the development of early intervention models that have been shown to improve outcomes for toddlers showing signs of ASD as young as one and two years old.

Dr. Landa recommends that as parents play with their infant (6 – 12 months), they look for the following signs that have been linked to later diagnosis of ASD or other communication disorders:

1. Rarely smiles when approached by caregivers

2. Rarely tries to imitate sounds and movements others make, such as smiling and laughing, during simple social exchanges

3. Delayed or infrequent babbling

4. Does not respond to his or her name with increasing consistency from 6 – 12 months

5. Does not gesture to communicate by 10 months

6. Poor eye contact

7. Seeks your attention infrequently

8. Repeatedly stiffens arms, hands, legs or displays unusual body movements such as rotating the hands on the wrists, uncommon postures or other repetitive behaviors

9. Does not reach up toward you when you reach to pick him or her up

10. Delays in motor development, including delayed rolling over, pushing up and crawling

“If parents suspect something is wrong with their child’s development, or that their child is losing skills, they should talk to their pediatrician or another developmental expert,” says Dr. Landa. “Don’t adopt a ‘wait and see’ perspective. We want to identify delays early in development so that intervention can begin when children’s brains are more malleable and still developing their circuitry.”

Wake up. Check your E-mail. Tweet about your breakfast. Google “calories in blueberry pancackes.” Browse calorie-burning apps on your smartphone.

Sound familiar? There’s no question that technology has made itself quite comfortable in our daily routines — from the second we wake up to the moment we wind down. In fact, a recent survey from the National Sleep Foundation (NSF) found that, across generations, 95 percent of Americans tune in to some form of technology, whether it’s television or texting, before hitting the hay.

Okay, okay. But electronics couldn’t have an effect on your sex life … could they? Actually, a number of recent studies have shown that technology does come with sexual side effects. Here’s the science:

Your Laptop Can Lessen Your Sperm Count

No matter where you are — at the office, on the couch, in bed — your trusty laptop is within reach. But recent research published in the journal Fertility and Sterility has found that your wirelessly connected computer may come with a scary side effect: It could undermine your sperm quality.

In the study, samples of sperm were collected and either stored normally or under a laptop that had a wireless connection. Within the laptop sample, more sperm had problems swimming normally and had more DNA damage, suggesting that direct exposure to the laptop’s radiation could hurt the chances of reproduction. In fact, the researchers speculated that keeping a computer near the testes “may result in decreased male fertility.”

Working From Home May Equal Erectile Dysfunction

With E-mailing cabibility on every device, it’s easier to take work home than ever before — but that may come with a downside: Experts link working around the clock to more stress and less sex.

“Stress from any cause is associated with adrenaline,” says Doron S. Stember, MD, a urologist at Beth Israel Medical Center in New York. “Adrenaline is an extremely potent anti-erection hormone. Since checking work e-mail at home is associated with high job-related anxiety, it can indirectly lead to erectile dysfunction.” The good news? This temporary type of erectile dysfunction is completely reversible — so try leaving your work at the office.

Smartphones Win Over Sex

Are you sharing your bed with technology? That could spell trouble for your sex life, says Dr. Stember.

In the same NSF survery, 21 percent of particpants confessed that they text before nodding off almost every night — and 36 percent of Americans curl up with their computers or laptops in bed before they fall asleep. The result? Less time spent making love and more time spent staring at screens. Besides being unromantic, “use of smartphones or tablets while in bed is associated with states of high adrenaline,” says Stember. Again, adrenaline works directly against erectile function.

Expects agree: Your bed should be used for two purposes and two purposes only — sleeping and sex.

Two’s Company, But Social Media’s a Crowd

Posting comments to Facebook and Twitter just before turning out the lights might be fun, but it’s less likely to lead to sex than actually talking with a loved one, says Stember. Ditto for texting with your loved one more often than having an actual conversation.

“In some cases, use of electronic devices in bed can signal to a man’s partner that he’s less than fully interested in them, and this contributes to a poor sexual dynamic,” Stember says.

How to Pull the Plug

“Many men have developed a habit of spending hours in front of the computer each night,” says Stember. “More computer time means less time interacting with their partners.”

The good news, Stember says, is that all of these issues are easily solvable. He adds, “Men who recognize a problem should make a conscious effort to limit their computer time to certain hours. Some people find it helpful to simply turn off their computers rather then letting them go into sleep mode. The simple inconvenience of waiting for the computer to boot up can provide a useful barrier to compulsive checking of e-mail or Facebook.”

Schoolteachers who underwent a short but intensive program of meditation were less depressed, anxious or stressed – and more compassionate and aware of others’ feelings, according to a UCSF-led study that blended ancient meditation practices with the most current scientific methods for regulating emotions.

A core feature of many religions, meditation is practiced by tens of millions around the world as part of their spiritual beliefs as well as to alleviate psychological problems, improve self-awareness and to clear the mind. Previous research has linked meditation to positive changes in blood pressure, metabolism and pain, but less is known about the specific emotional changes that result from the practice.

The new study was designed to create new techniques to reduce destructive emotions while improving social and emotional behavior.

The study will be published in the April issue of the journal Emotion.

“The findings suggest that increased awareness of mental processes can influence emotional behavior,” said lead author Margaret Kemeny, PhD, director of the Health Psychology Program in UCSF’s Department of Psychiatry. “The study is particularly important because opportunities for reflection and contemplation seem to be fading in our fast-paced, technology-driven culture.”

Altogether, 82 female schoolteachers between the ages of 25 and 60 participated in the project. Teachers were chosen because their work is stressful and because the meditation skills they learned could be immediately useful to their daily lives, possibly trickling down to benefit their students.

Study Arose After Meeting Dalai Lama

The study arose from a meeting in 2000 between Buddhist scholars, behavioral scientists and emotion experts at the home of the Dalai Lama. There, the Dalai Lama and Paul Ekman, PhD, a UCSF emeritus professor and world expert in emotions, pondered the topic of emotions, leading the Dalai Lama to pose a question: In the modern world, would a secular version of Buddhist contemplation reduce harmful emotions?

From that, Ekman and Buddhist scholar Alan Wallace developed a 42-hour, eight-week training program, integrating secular meditation practices with techniques learned from the scientific study of emotion. It incorporated three categories of meditative practice:

• Concentration practices involving sustained, focused attention on a specific mental or sensory experience;
• Mindfulness practices involving the close examination of one’s body and feelings;
• Directive practices designed to promote empathy and compassion toward others.

In the randomized, controlled trial, the schoolteachers learned to better understand the relationship between emotion and cognition, and to better recognize emotions in others and their own emotional patterns so they could better resolve difficult problems in their relationships. All the teachers were new to meditation and all were involved in an intimate relationship.

“We wanted to test whether the intervention affected both personal well-being as well as behavior that would affect the well-being of their intimate partners,” said Kemeny.

As a test, the teachers and their partners underwent a “marital interaction” task measuring minute changes in facial expression while they attempted to resolve a problem in their relationship. In this type of encounter, those who express certain negative facial expressions are more likely to divorce, research has shown.

Some of the teachers’ key facial movements during the marital interaction task changed, particularly hostile looks which diminished. In addition, depressed mood levels dropped by more than half. In a follow-up assessment five months later, many of the positive changes remained, the authors said.

“We know much less about longer-term changes that occur as a result of meditation, particularly once the ‘glow’ of the experience wears off,” Kemeny said. “It’s important to know what they are because these changes probably play an important role in the longer-term effects of meditation on mental and physical health symptoms and conditions.”

By Marielys Camacho-Reyes / VOXXI Health.    When was the last time you had a big challenge in your life and you said to yourself, “I can do this”? Or the last time you gave yourself credit for a well-done job? If you are having a hard time remembering when – or if the answer is never – it is probably because you are experiencing what is called “low self-esteem.”
People with low self-esteem tend to see other people as more capable, beautiful, and intelligent and feel like no matter what they do, they will never match up to other people’s achievements. Basically, they have no confidence in themselves.

Self-esteem is the evaluation we do of ourselves and how we emotionally respond to that evaluation. It plays an essential role in the way we all face challenges in life. At the same time, it is considered the number one “tool” used by individuals when trying to achieve goals.

For those with low self-esteem, experiences and challenges in life – especially those that require the person to make important decisions – may seem terrifying.

People with low self-esteem also show a marked inability to make commitments and lack of confidence in their abilities. Most of the time, they do not recognize that they have a problem until life starts falling apart right in front of their eyes, and they find themselves struggling to survive.

These are six tips to help you build a stronger self-esteem, so you can improve the quality of your life and the life of those around you.

• Accept the fact that you are not perfect

Accept yourself with the good and the not-so-good qualities. Remember – no one is perfect, and you shouldn’t pretend to be. It is okay to make mistakes and to have flaws. The important part is to learn from your mistakes and not to allow your flaws to interfere with the achievement of your dreams and goals.

• Know where you want to go in life

Create a plan for your life. Knowing where you want to go in life and how you will get there, will help you turn your dream into a reality without wasting time trying to understand what your purpose in life is.

• Do not compare yourself with other people

As simple as that, my friends. Stop comparing yourself with others. Like my grandmother used to say, “You are not better that anyone, but no one is better than you.” Always remember that!

• Identify both your strength and weaknesses

By identifying your strong and weak points, you will have a better chance in learning how to use them to your advantage and how to improve, which will empower you and give you more confidence.

• Work on improving your weaknesses

Once you identify your weaknesses, make a point to improve in those aspects. Taking care of those areas in your life that need to be re-invented will help you have a different opinion of yourself.

• Love yourself no matter what

That’s it guys, love yourself because if you don’t, how do you expect anyone else to love you?

Developing, building, and maintaining a high self-esteem may seem like an agonizing job, but it doesn’t have to be. It only requires you to constantly believe in yourself and in the good things you have to offer to the world.

So go ahead, repeat, “I’m the creator of my own destiny and no matter what challenges life has in storage for me, I know I can handle them, and I will do it.”

Many people keep bipolar disorder a secret from their friends, love interests, co-workers, even family members. Follow this step-by-step guide to striking up this important conversation.  Filling someone in on your health history may not be your typical ice-breaker — and for people with bipolar disorder, sharing the diagnosis can be emotional and challenging.

But bipolar disorder is nothing to be ashamed of, and if you are proactive about starting the conversation, you will set a positive tone, whether you’re breaking the news to a family member, your boss, or a new love interest.

In fact, there are many reasons you should be open about bipolar disorder. “If patients carry their diagnosis around as a secret, it becomes a burden and they may feel even worried and alarmed that people are going to find out,” says psychiatrist Daniel Wilson, MD, chair of psychiatry at Creighton University in Omaha, Neb. Sharing can lighten your emotional load.

Other reasons to have the “bipolar chat” include:

• Getting support. Just as when you have the flu, you will need the love and care of people around you during bipolar treatment and they, in turn, will appreciate knowing what’s going on with you.
• Educating your loved ones. Finding a way to talk about bipolar disorder will allow you to inform the people in your life about your symptoms, as well as your bipolar treatment.
• Identifying bipolar triggers and symptoms. People around a person with bipolar disorder are often the first to notice bipolar symptoms, particularly with mania. “Patients don’t always have the same degree of awareness of what’s happening,” says Dr. Wilson.

Breaking the News About Bipolar Disorder: An Eight-Step Guide

Once you decide that it’s time to tell others about your bipolar disorder, planning the conversation can be challenging. Use these step-by-step strategies:

1. Pick a calm moment. Too often, these conversations are forced by a crisis, says Wilson. “It’s better to have the conversation when the person is feeling well,” he says. That’s why you should share your diagnosis before another episode requires an immediate response. If you can choose the location, find a place where you feel comfortable and one that offers privacy for everyone involved.
2. Practice. It’s always a good idea to make a trial run with important conversations. Your therapist or a friend who already knows about your situation could be a good sounding board.
3. Fine-tune for your audience. Your exact words will be different if you are talking to a family member, a romantic partner, or a co-worker — so plan accordingly. For example, when you are talking to your boss, it might be helpful to bring along some of the highlights of your work history to show that you’ve been a productive employee over the years despite bipolar symptoms. If you are talking to a new love interest, it’s best to pick a time early in the relationship out of respect for your partner’s right to make choices about continuing to date you with full knowledge of your situation.
4. Be a teacher. There’s a good chance the person you are talking to doesn’t know much about bipolar disorder. Come prepared with helpful information. Bring pamphlets or contact information for a support group if you think that would help, or invite the person to meet with your counselor or doctor to fully understand your bipolar treatment.
5. Shut out stigma. You might be able to help your loved one better understand the implications of your diagnosis if you use a disease analogy. “I like to compare it to an overactive thyroid,” says Wilson. “Clearly you want to treat that condition.”
6. Make amends. If appropriate, you might want to acknowledge damage done by past behavior caused by bipolar symptoms. “Explaining that it wasn’t just a personal preference to behave in a particular way and that there is this medical aspect to it can be helpful,” says Wilson, adding that many patients feel guilt and shame over their actions and sincerely want to make amends. In some cases, both the disclosure of your diagnosis and acknowledging the impact of your choices might both be better handled in a letter.
7. Give them time. Some people are very open and flexible, but others — possibly family members with rigid ideas about family identity — can have a hard time digesting your news. “It’s often helpful to have a cooling-off period, letting people go their own way for a while,” says Wilson.
8. Accept their responses. Sharing your bipolar diagnosis may leave you feeling vulnerable and, unfortunately, not everyone will respond the way you wish they would. “I’ve had to advise patients to limit their contact with some family members for a while,” says Wilson. Talk to your therapist if you’re disappointed about the response that your disclosure received.

Keep in mind that what the person you are talking to does with the information you share is out of your control. “I’ve seen many cases of excellent, supportive work situations, and situations in which when people at work found out, they clearly tried to shuffle the person out of the job,” says Wilson.

To better help you manage this unpredictability, Wilson advises involving your counselor or therapist along the way, especially if your disclosure causes a major shake-up in your family dynamic or triggers denial or hostility.

By VOXXI Health.  Next time a woman complains about how dumb her blind date is, there may be some science to come to his defense, and re-evaluate the whole dating scene. A 2009 study suggests that men, in the presence of an attractive woman or a woman, actually become cognitively impaired. And a more recent study shows that  just knowing a woman might be watching him was enough to make a man’s cognitive abilities slip.

This gives a whole new meaning to the term, “performance anxiety.”

The Dutch study asked men to perform a “Stroop test,” a basic cognitive assesment, where subjects look at cards with the name of a color printed in a different ink color. So the word “red” might be written in green ink, for example. They are then asked to identify the ink color as quickly as possible – tricky when our brains are registering the word, along with the color, together.

When performing the Stroop test before and after interacting with a woman, men performed much lower during the “after” stage. Likewise, when men were told they were being observed by an unseen female researcher – their performance slipped markedly.

Researchers attribute the cognitive impairment to possible instinctual factors: It could be that men’s brains are so hard-wired to search for mating opportunities that they regard almost every woman as a potential mate. So when men are concerned about impressing a woman, they may be acting by instincts and their brains don’t function as well.

So ladies, next time you’re on a first date and the guy says something stupid, drops his keys or steps on your foot, cut him some slack. After all, it’s your fault, not his –  he’s just  cognitively impaired!

Fifty-six cigarettes. That’s what one 45-minute session of smoking hookah—a type of communal waterpipe gaining popularity in North America—feels like to your lungs, according to a recent study in the Journal of Nicotine and Tobacco Research.

In the study, researchers examined people as they smoked a hookah for 45 minutes—the length of an average session—and another day when they smoked one cigarette each. Pressure sensors measured how much smoke each person inhaled. (More from Men’s Health: Why Are Men Still Smoking?)

The results? The cigarette-smoking group inhaled 1.1 liter of smoke, while the hookah group inhaled 61.6 liters.

“What concerns me the most is that these were relatively inexperienced hookah smokers,” says Thomas Eissenberg, Ph.D., Director of Clinical Behavioral Pharmacology at Virginia Commonwealth University and author of the study. “Hookah tobacco contains the addictive drug nicotine, so users run the risk of getting hooked. The more comfortable users are smoking from the pipe, the more smoke they inhale.” The risks don’t stop there, either: Water pipes are also hosts for viruses like herpes, hepatitis, and tuberculosis, according to a study by Danish researchers.

Conclusions like those run counter to the popular notion that smoking hookah tobacco is safer than smoking cigarettes. “There are dramatically more cancer-causing chemicals and carbon monoxide in hookah smoke than there are in cigarette smoke,” Eissenberg says. “When it comes to other toxins cigarettes contain such as tar and heavy metals, hookah may contain more or less. We simply don’t know.”

Even abstaining from a puff or two might not help if you happen to be sitting in the same room as your hookah-smoking buddies. “There is no reason to believe the second-hand effects of hookah smoke,” Eissenberg says, “differ from those of cigarette smoke.”

By: Julie Hanks LCSW

Patient Question:

I’ve been sitting here for 30 minutes trying to formulate my thoughts into a paragraph but I can’t do it so I’m just going to list feeling as they come to mind.
1. I feel nothing on a regular basis. For example if I got a call saying that my mother died, I don’t think I would even cry.
2. I’m irritable beyond belief. If someone asks me to do something I get pissed for them even asking me.
3. I’m not suicidal, but I constantly question why I’m living and try to come up with reasons to continue on.
4. I don’t see people as individuals. I see everyone as a mammal, which leads me back to number 3.
5. I want to ask my parents, or anyone for help, but I’m afraid of being laughed at.
6. I don’t even try to interact with girls. I’m not homosexual at all, I’m still attracted to girls, but the effort I need to put in to get an outcome is unbalanced.
7. I observe everyone’s actions with relationships and reasoning and feel like everyone is, for lack of a better term, retarded.
8. I bite my fingers all the time, not just the nails, but the skin around it. After searching the internet I found over-focused ADHD which I believe I fit all the symptoms of.
9. I smoke weed. I’m not addicted to it, but it is the only thing that makes me happy. When I’m high my constant racing thoughts calm down allowing me to live normally.
10. Sometimes I get stuck on negative thoughts and experiences. For example, if I call a friend and they don’t answer I immediately think they are ignoring me and go into a downward spiral of depression until I hear back from them.
I’m sure there is more but as it is it took me an hour just to get those 10 down. Please help with some kind of advice.
Thanks – Lost Teenager

Therapist Answer:

Please reach out for help from your parents as soon as possible. Ask them to take you to a psychotherapist or psychiatrist to get a mental health evaluation.

Though I can’t diagnose you without seeing you in person, I can tell you that what you are describing sounds to me like depression — the empty feeling, the extreme irritability, and the difficulty finding a reason to live, social withdrawal, and negativity. The good news is that there are several very effective treatments for depression, including cognitive behavioral therapy, psychodynamic therapy, and medication treatment. If your parents have generally been supportive of you in the past, they will likely respond positively to your request for help. If for some reason they aren’t supportive, please reach out to another adult, like a school counselor, for help. You don’t have to live the rest of your life with this much emptiness and disconnection.

Hypothyroidism, a heart attack, or an upsetting recent event can all provoke depression. Find out how doctors determine whether your depression stems from a medical condition or another cause when they make their diagnosis.

Despite common misconceptions, depression is not a short-lived bout of sadness that you can diagnose and treat on your own. Depression is a serious condition with potentially severe symptoms — it should be assessed and monitored by a qualified medical practitioner.

That said, you can help your practitioner make an accurate diagnosis of depression by paying attention to any feelings of persistent sadness that seem unusually strong and by familiarizing yourself with the most common symptoms of depression.

Depression Symptoms

When you suffer from depression, you may:

• Have trouble concentrating
• Feel sad, anxious, or empty
• Feel guilty, worthless, or helpless
• Experience fatigue or a general lack of energy
• Be irritable and restless
• Experience a loss of interest in normal activities
• Have persistent headaches, digestive problems, or other physical complaints that don’t go away with treatment
• Have thoughts of suicide or attempt suicide   

Seeking Help

If you experience one or more of these depression symptoms for more than a few days, your first step should be to make an appointment with your primary care physician, a psychologist, a family services representative, or another health care professional who can help diagnose and treat a potential depressive disorder.  It’s important for you to be as open as possible with your practitioner about all your symptoms — both emotional and physical — whether they seem to be related to depression or not, as sometimes an underlying medical condition can cause depressive disorders.

What to Expect at Your Screening

Here’s what will probably happen at your doctor’s appointment:

• Emotional and lifestyle assessment. Your practitioner may use one of several written screening tests, such as the 21-question Beck Depression Inventory, which asks about the degree and frequency of your symptoms. In addition, the practitioner may ask about recent events in your life that may have brought on depression, and whether you have a family history of depression, which is often a precursor to depressive disorders.
• Discussion of preexisting medical conditions. Your doctor will want to discuss any preexisting medical conditions, such as heart disease, stroke, cancer, diabetes, or Parkinson’s disease, each of which can trigger a depressive disorder. An estimated 40 to 65 percent of heart attack patients, for example, also have depression, at least in part because of the emotional impact of experiencing a serious medical condition; but even 20 percent of those with coronary artery disease who have not yet had a heart attack also develop depression.
• Physical exam and discussion of current physical symptoms. Your medical practitioner may want to examine you and perhaps conduct lab tests, looking for any undiagnosed medical conditions that can cause depression. These medical conditions include hypothyroidism, a condition of the thyroid gland that causes a general slowing of your metabolism. Certain viruses have been linked to depression, in particular the human Borna disease virus, which attacks the neurological system. Deficiencies in vitamins and minerals, such as folic acid and vitamin B₁₂, have also been linked to depression.
• Discussion of current medications. Your practitioner will ask about any medications you are taking, because depression can be a side effect of some medications.

Perhaps this type of medical screening will become obsolete in the future: Researchers are working on a brain-scanning tool that may one day operate like an electrocardiogram for the brain, helping detect depressive brain activity and conclusively establishing a diagnosis of depression.

Treatment

If you are diagnosed with a depressive disorder, you may be prescribed antidepressants. If an underlying medical condition is causing your depression, its treatment may be all you need to take care of your symptoms of depression. Or you might be referred to a mental health practitioner, such as a psychologist or a psychiatrist, who can provide talk therapy and monitor your progress.

If your practitioner sends you home with a diagnosis of depression, take heart: Studies show that treatment is successful for most patients. But remember that before you can get treated, you need to seek help.

By Chris Iliades, MD.   Which relationships are the most important to you — your family members, your partner, your long-time best friend?

For many people with depression, there’s another type of bond altogether that can impact life in a significant way: The relationship with your therapist. Regular sessions with a counselor can be an integral step to successfully treating depression — in fact, a recent review of 38 studies of talk therapy published in the American Journal of Psychiatry concluded that talking with a therapist is an effective form of depression treatment, while a combination of therapy and medication tends to be the most beneficial. And that’s why it’s so important that this relationship is healthy and thriving (and assessed every now and again).

Here’s the first thing you should do to ensure your therapist is a good match: “Figure out if you are in the right type of therapy,” says Katherine Krefft, PhD, a psychologist in Buzzards Bay, Mass. Talk therapy can be given by a psychiatrist, a psychologist, or a clinical social worker — and counseling comes in a number of different forms.

“Anyone who’s considering talk therapy should go into therapy with some clear goals for what they want to accomplish,” adds Mackenzie Varkula, DO, a psychiatrist at the Cleveland Clinic. “Pick a time frame and ask yourself if your goals are being met.”

And if your goals aren’t being met? It may be time to find a new therapist.

How to Assess Your Therapist

Just because a therapist is good doesn’t mean she’s a good therapist for you. As with any relationship, there needs to be trust, communication, and a meeting of the minds. How can you tell if the relationship is working?

If you find yourself answering “no” to most of these questions, your therapist may not be the right match for you:

• Do you have good chemistry with your therapist? “You should know early on if you have the right comfort level. If you find yourself holding back and unable to share and be completely honest, it is not a good start,” says Dr. Varkula.
• Do you want to go back for another therapy session? If you feel positive about the sessions after the first few appointments and want to continue, Krefft says, that’s a good sign that the therapeutic relationship has gotten off on the right foot.
• Do you have a positive attitude about therapy in general? Feeling negatively about your therapist could be due to bad chemistry, but it could also be due to a bad attitude on your part. “Some people go into therapy thinking it won’t work because of past experiences,” Varkula says. “Just like any relationship, you shouldn’t give up until you have given therapy a fair chance to work.”
• Are you learning about yourself? “During the early part of therapy, you should already be learning new things about your emotions and behaviors,” Krefft says. “Your therapist should be giving you tools to start working on some changes.”
• Are you able to draw on what you’ve learned in everyday life? “After being in therapy for a while, you should be able to start using your therapy tools in the real world between therapy visits,” says Varkula.
• Does your therapist show you respect? “A good therapist should give you unemotional positive support,” Krefft says. “You should never feel like you are being judged.” You should also not feel that you are being told what to do, but rather that you are being listened to and respected, she adds.
• Is your life getting better? “After some time in therapy, you should start to see some positive changes in your life that come from using the knowledge and the tools you are getting,” says Krefft. “You should not feel dependent on your therapist — you should feel as if you are learning how to figure things out.”

Also keep in mind that treatment for depression can change over time. Just as with other relationships, the therapy relationship may have changing needs. “As situations change, you may be able to end therapy or you may need to change to a therapist with different abilities,” says Varkula.

A good therapy relationship takes a good therapist and a good patient. Ask yourself if you are holding up your end of the bargain. “Therapy requires work and commitment,” Krefft says. “It’s not just like talking to your best friend. You can do that for free.”

By Gerti Schoen, MA, LP..    Sometimes our partners become very irked and wounded when we just try to make conversation. They take any little comment as a criticism of them and turn a harmless inquiry into a paranoid insult.  If it feels like you have to walk on eggshells, that doesn’t mean your partner has a borderline personality disorder. They might just be a gentle soul on the verge of a breakdown.

One of the couples I see, let’s call them Phil and Jen, have these kinds of exchanges frequently. Jen is highly sensitive when it comes to her appearance. All her feelings of inadequacy have been displaced onto her body, which is now the battleground for her ongoing self improvement projects.

Phil thinks there is nothing wrong with Jen’s body. He doesn’t mind that she has a little fat around her belly, and is honestly convinced that she is beautiful. Jen tries to believe him but can’t quite pull it off. The belief that she is unattractive is stronger than his loving reassurances.  The other day Phil comes home from work, opens the fridge and asks innocuously, “Did you finish the leftovers?”

He should have known better. Jen took it as a criticism, thinking he blamed her for eating what she couldn’t really allow herself to eat.
Instead of just answering yes and moving on, Jen threw a fit and blamed Phil for just not getting it. She expects him to be aware of her sensitivities at all times and hold back any comment that might be hurtful for her.

Phil in return gets mad because he feels he shouldn’t have to censor his every utterance and wants Jen to just get over her paranoia.
What is required is a mutual understanding of where each partner is coming from.  Phil is already aware of Jen’s vulnerabilities, but when he comes home tired and stressed and in need of some reassurance himself, he just doesn’t have it in him to then go and take care of her emotional needs.

Jen too knows very well that she tends to overreact, but sometimes has only enough energy to sooth her own fears and runs out of patience when Phil too has had a bad day.  This is when they clash: when both are in need of comfort, and none of them has enough to give to the other.

They have learned it’s best to just give each other some room to breathe and then come together and talk about what bothers each of them. Jen ultimately has to fess up to her sensibilities and try to accept that she can be difficult at times.  When we are able to make jokes about our inadequacies and not take them so seriously, this is when we are on our way to be free from the insecurities that haunt us.

Obsessive-compulsive personality disorder is a fairly common psychiatric disorder that wrecks havoc with peoples’ lives.  This disorder occurs in early adulthood and involves a preoccupation with orderliness, perfectionism and mental and interpersonal control that interferes with day-to-day functioning. The rigidness and perfectionism of these patients often results in indecisiveness and preoccupation with detail and insistence that things be done their way.  They may have problems socially and these behaviors may interfere with their effectiveness at work.

Sometimes these people are stingy, they are savers, and often refuse to throw away things they no longer need. They are list makers, workaholics who meticulously plan for their own pleasure and resist authority of others but insist on their own. Their time is poorly allocated and tasks are left to the last minute.

Patient: “Robin”

Robin admitted she was over the top when it came to neatness. She worked for the district attorney’s office and often had a problem completing her work. She was extremely neat and factual with her work and never had a misspelled word or issued a report that was not factual.

In fact, her work was perfect. Her boss, Ray, had called her in his office and asked her why she could not complete her work in a timely manner.  Robin had always been orderly. Her mother had insisted on a clean and orderly house and often had lists of chores to be completed. The habit had stuck and Robin made so many lists that sometimes she became lost in them.  She admitted to her boss that nearly every night she stayed late at work and thoughts of work kept her up late.

Robin would meet the criteria for obsessive-compulsive personality disorder. She was a workaholic and a perfectionist to the point that it interfered with her job. She over concentrated on her tasks so much that sometimes she did not accomplish the tasks themselves. As a depressed mood is common in these patients Robin should be evaluated by a mental health professional.

Education, medication, and treatment is the triple approach to OCD. Self-education is a priority. A website to go to is the Obsessive Compulsive Foundation, www.ocfoundation.org.

It is now accepted by the medical profession that the cause of OCD may be a neurotransmitter in the brain called serotonin that is responsible for controlling mood states and is believed to control repetitive behaviors.

Medications such as Selective Serotonin Reuptake inhibitors are used including Anafranil, Zoloft and Prozac. I have found in my practice that psychotherapy, behavior therapy, and the adjunct of medical hypnosis has beneficial in the treatment of OCD.

I am a 16-year-old girl and it has recently been pointed out to me a lot how…weird I am. People say I’m too paranoid and I’m too much of a perfectionist. I’m also noticing other things that I’m beginning to feel freaked out about.  First, I have ‘quirks’ that are quite strange. The things I do…well…I eat chips in order of size, small to big; there’s no reason. I eat things like peas in even numbers. I don’t like odd numbers except multiples of 5, and the number 3. Volumes on TVs have to be even or a multiple of 5.

I like to count a lot, and touch. I walked by a candle display once and stopped to count them, tapping them in a rhythm: 1 2 3, 4 5 6, 7 8 9… If it didn’t end on the third number or an even number or a multiple of five, it would feel ‘off.’  I like symmetry and neatness. Everything has a place and it stays there. Like in school, pens at the top right then, moving left, pencils, rubber and ruler. Sheets on the left, parallel to the edge, with the one I’m writing on in the middle of the table.

I’m a very ‘paranoid’ person. If I can’t get something right about myself and leave the house, then people are staring at me; they are laughing and whispering. They laugh at a scuff on my shoe or a wrong colored hair slide from the rest. Other people don’t care how people see them; but they could have weapons, looking to kill someone — and why not the weird girl?

I freak out if people follow me when I’m walking. When they start to catch up I get worse. I close my eyes as they pass. I’ve not been jumped yet though.  There is someone in my room. I keep…’feeling’ him, and can’t get to sleep; or I wake up, heart pounding.

I think people don’t like me and think me weird. Can you blame them? They are loved ones who don’t love back. Could this explain the thoughts I’ve had? ‘Your best friend is dead.’ ‘Kick your 1-year-old cousin in the head.’ ‘Stab your sister with that knife you’re drying.’ I hate these thoughts! They appear suddenly and won’t leave until I do things like clean or organize things and revise my schoolwork.

I think about death sometimes. “Am I better dead?” “How would I do it?” Or I think of myself in accidents or murdered. Today a thought went through my head, “Someone kill me. Someone kill me. Someone kill me.” Why?

I can’t keep still. People tell me to stop bouncing or swinging, but I can’t help it! And I get songs stuck in my head all the time! They don’t leave until new ones replace them.  I haven’t been diagnosed with anything, nor taken drugs or alcohol.  Am I normal?

Clinical Psychologist’s Reply

By Dr Shailagh Clarke, PhD | 28 March 2012 (Please read our Important Disclaimer.)

A:

You ask if you are normal, and that is an interesting question. Some might say that it is ‘normal’ to have problems or even mental health concerns, because it is such a common experience. However, I know that you are wondering whether the thoughts and behavior patterns you have noticed are typical of all people. Without discussing what you are experiencing with you in person, there is much room for error. Perfectionism or paranoid thoughts by themselves do not mean that you are abnormal. If we met in person I would be exploring with you how strongly you believe the thoughts (e.g. “there is someone in my room” or “I must look perfect or they will kill me”) and how these thoughts affect you on a daily basis. I would encourage you to discuss your experiences with a professional if the paranoia becomes so overwhelming that you are feeling too fearful to function as you need to. Also, if you are aware of hearing or seeing things that others do not hear or see, you would probably benefit from consulting with a mental health professional.

The other pieces that you described in your post sound like obsessions and compulsions, which are typically part of an anxiety disorder called Obsessive Compulsive Disorder (OCD). (Again, it is always a good idea to take my one-shot opinion to a professional who knows you well!)  Obsessions are repeated, unwanted thoughts and images that enter the mind. People can have obsessions about various things, including contamination, violence or aggression (e.g. hurting someone), or the need to have things just right. Obsessions can also be religious or sexual in nature. One thing all obsessions have in common is that they are very upsetting to the person who is having them. In your case, one example of an obsession would be the thought about harming your sister.

You also mentioned that you are counting in your head, sorting objects, eating in a ritualistic way, checking, and touching things. These behaviors sound like compulsions. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) defines a compulsion as a repetitive behavior or mental act that one feels driven to perform in order to prevent or reduce distress, or to prevent some dreaded situation. Some common compulsions are hand washing, touching something, checking (e.g. to see if something is closed or off), counting, or repeating words silently. Again, in your case, the distress that you feel related to the thought about harming your sister is reduced once you have organized or cleaned your possessions.

Obsessions and compulsions go hand in hand. For example, if someone obsesses about contamination, he might compulsively wash his hands after touching anything, up to hundreds of times per day. Washing reduces the perceived likelihood of contamination, and therefore relieves anxiety (temporarily). In other cases, the connection between the obsession and the compulsion does not make intuitive sense. For example, your thoughts about harming family members create the need to clean or organize until it ‘feels right.’

You did not mention how often the obsessions and compulsions occur or how long they last. Part of having OCD is that the presence of the obsessions or compulsions themselves causes distress, they take more than one hour per day, or they significantly disrupt your daily routine. The good news is that OCD is a highly treatable disorder, with both therapy and medication. If you would like to seek professional help, it would probably be best to find a therapist who specializes in treating OCD. The particular type of cognitive behavioral therapy that a specialist would likely provide is called exposure and response prevention (ERP). With this treatment, you would learn to cope with the discomfort triggered when things are not just right (exposure) without engaging in the compulsion to sort, order, or touch things (response prevention). This will take some practice and persistence on your part, but many have successfully learned to manage their symptoms of OCD.

Another treatment option is psychotropic medication. Your medical provider could be a first stop for a referral to a psychiatrist who can talk to you about what you are experiencing and find the right medication for you. People can begin with therapy or medication, or do both together.

If you would like more information about OCD, check out the International OCD Foundation. You can find referrals for therapists, recommendations for self-help books, and information about whether there are support groups in your area.

By Kelly Babcock… Twice in the past seven days I’ve managed to forget my meds. I take Concerta, which is Methylphenidate.  Methylphenidate is better known in our tribe as Ritalin. Did you know that Ritalin was named after the wife of its creator? Ciba chemist, Leandro Panizzon formulated methylphenidate.  His wife, Marguerite (her nickname was Rita), suffered from low blood pressure and took the stimulant before playing tennis. One assumes that it may well have helped her focus on the game as well as keeping up her blood pressure.

Ooooops

Damn, I’m wandering, I was trying to tell you that I may wander because today is one of those two days that I forgot my medication. Apparently I can’t tell you that I’m wandering – without wandering.

Back to the story

Late this afternoon I realized I hadn’t taken my Concerta. I don’t crave it, I only notice I’ve missed it if I notice I’m having trouble focusing. Even then, I have to have the presence of mind to question the missing focus. Today (Tuesday) was the day from hell. I slept poorly, had a 150 mile return trip drive to an emergency dental appointment. I had to be home in time for an evening class.

Opportunity knocks … and I feel it

While on the road to a bigger urban center, I thought I’d pick up a few things that I’ve been wanting, so I made several stops. This is way outside my usual day, way beyond my comfort zone you might say.

Not the carefree life I normally lead

It took a while to realize, given that my day was so different, that I was not focused, not calm. While coming home and expecting things to calm down, I found that they weren’t. It took that to clue me in; I had no stimulant on board.

Oh oh, The night school horror show – part two

I cringed emotionally when I remembered I had to attend a class this evening. The last time I took a class without medication was prior to my diagnosis. I took my digital recorder to one of the freelance journalist classes to help with the display of “tools of the trade” and somehow managed to turn it on. It faithfully recorded over 40 minutes of me interrupting, talking out of turn, drumming my fingers, tapping my pen, just being a general all around ADHDer. Was I destined to repeat that at tonight’s class? I vowed I would not.

Man of DistrAction is supposed to be a super-hero name. I’m supposed to stop speeding locomotives, or leap tall buildings, all that stuff, and here I was afraid of taking a class without my stimulant medication.

It was, of course, way to late to take it, it would just be wearing off on Wednesday morning. I bit the bullet, climbed into my trusty pickup truck and, feeling like I was lost in a Joni Mitchel song, I headed into town.

“Class, come to order now … ”

I sat down and reminded myself I was here to learn, and I was just going to have to do that. If my scattered and unfocused approach to classwork caused others to have issues, that would be bad, my bad. I would do my best to restrain and refrain, I did not want to feel like I was letting others down. I bit my tongue.

How did that go?

I think I pulled it off. Class went well, I’ll talk more about that on Friday.

Possibly because of my sheer exhaustion I sat and listened. I spoke when it was my turn, mostly. When I spoke I kept it to a minimum and kept on topic. I behaved well …

And then I bolted!

As soon as class ended I left without fanfare. I made it home without incident and slipped into bed to catch up on the rest I had missed the night before. As my mind slowed down to the mildly wild hum that allows me to sleep, and as I drifted off into that sleep I thought to myself “I could handle another day like that … But I don’t ever want to!”

A cognitive training program that included Sudoku and crossword puzzles made older adultsmore open to new experiences, according to a preliminary study.  After 16-weeks of training in inductive reasoning, participants demonstrated more willingness to try new activities than a control group, reported Joshua Jackson, PhD, from Washington University in St. Louis, and colleagues in Psychology and Aging.

Older adults undergo changes in personality, including shifts in openness or willingness to seek out new and cognitively challenging experiences. A number of interventions have been designed to enrich cognitive functioning in older adults, but little has been done to develop openness, the authors explained.  “We hypothesized that an intervention aimed at improving cognitive functioning would change the personality trait of openness,” they wrote.

Participants were recruited from an ongoing community-based cognitive intervention program. The mean age of the seniors was 72.9 and 94 percent were white. On average, participants had completed 15.5 years of education.  Seniors could not be involved in the study if they were engaged in more than 15 hours of work or volunteer activities per week. Other exclusion criteria included stroke in the past three years, active cancer treatment, or a scores of less than 24 on the Mini-Mental State Examination.

Participants were randomized into an intervention group or a waitlist control group. They were paid by the researchers for finishing all of the study assessments. The intervention group saw a 92 percent completion rate among 85 enrollees; the control group had an 89 percent completion rate among 98 enrollees.  The intervention consisted of a classroom-based inductive reasoning training program that focused on novel pattern recognition. Participants also did home-based Sudoku and crossword puzzles. Puzzle sets were matched to each person’s skill level based on his performance during the previous week, and increased in difficulty when appropriate.

Participants underwent personality trait and inductive reasoning tests before, during, and after the study to analyze the effect of training on openness to experience.  At pretest, there were no differences between the two groups for openness to experience or a composite measure of inductive reasoning skill. The training led to increases in inductive reasoning in the study arm compared with controls.

The authors reported that post-test openness scores were higher for the training group than for the control group.

They also noted that changes in inductive reasoning did not mediate the effect on changes in openness. This suggested that cognitive intervention influenced openness above and beyond increases in inductive reasoning.

The ‘use it or lost it’ tag is often attributed to these types of studies, they pointed out, and “the current results suggest that ‘using it’ also can lead people to view themselves as more open … openness to experience is linked to better health and decreased mortality risk.”

The study had some limitations. It did not examine the mechanisms by which changes in openness occurred. The authors also could not determine if the intervention effect was because of the inductive reasoning training, the puzzles, or both.  Finally, the participants were not actively involved in other activities so the results may not have general application.

However, the authors stressed that their study is one of the first to demonstrate that personality traits can be altered with nonpyschopharmocological interventions. Future research should look at the range of cognitive activities that could lead to personality changes.

Most parents are aware that their child’s feelings of self-worth are linked with their success socially and academically. But, sometimes parents are unaware of how easy it is to damage their child’s self-esteem without even realizing it. Research shows that children with learning disabilities are more likely to suffer from lack of self-esteem than their peers. The Coordinated Campaign for Learning Disabilities, along with Dr. Robert Brooks, have compiled a list of ways parents can develop positive feelings of self-worth in their children.

Help your child feel special and appreciated. Research indicates that one of the main factors that contributes to a child developing hope and becoming resilient is the presence of at least one adult who helps the child to feel special and appreciated; an adult who does not ignore a child’s problems, but focuses energy on a child’s strengths. One way for parents to do this is to set aside “special time” during the week alone with each child in the household. If the child is young, it is even helpful for the parent to say, “When I read to you or play with you, I won’t even answer the phone if it rings.” Also, during these special times, focus on things that your child enjoys doing so that he/she has an opportunity to relax and to display his/her strengths.

Help your child to develop problem-solving and decision-making skills. High self-esteem is associated with solid problem-solving skills. For example, if your child is having difficulty with a friend, you can ask him/her to think about a couple of ways of solving the situation. Don’t worry if your child can’t think of solutions immediately, you can help him/her reflect upon possible solutions. Also, try role playing situations with your child to help demonstrate the steps involved in problem-solving.

Avoid comments that are judgmental. Instead, frame them in more positive terms. For example, a comment that often comes out in an accusatory way is, “try harder and put in more of an effort.” Many children do try hard and still have difficulty. Instead say, “We have to figure out better strategies to help you learn.” Children are less defensive when the problem is cast as strategies that must be changed rather than as something deficient with their motivation. This approach also reinforces problem-solving skills.

Be an empathetic parent. Many well-meaning parents, out of their own frustration, have been heard to say such things as, “Why don’t you listen to me?!” or “why don’t you use your brain?” If your child is having difficulty with learning, it is best to be empathetic and say to the child that you know he/she is having difficulty; then the parent can cast the difficulty into a problem to be solved and involve the child in thinking about possible solutions.

Provide choices for your child. This will also minimize power struggles that may arise. For example, ask your child if he/she would like to be reminded 5 or 10 minutes before bedtime to get ready for bed. These beginning choices help to set the foundation for a feeling of control of one’s life.

Do not compare siblings. It is important not to compare siblings and to highlight the strengths of all children in the family.

Highlight your child’s strengths. Unfortunately, many youngsters view themselves in a negative way, especially in terms of school. Make a list of your child’s “islands of competence” or areas of strength. Select one of these islands and find ways of reinforcing and displaying it. For example, if your child is a wonderful artist, display his/her artwork.

Provide opportunities for children to help. Children seem to have an inborn need to help others. Providing opportunities for children to help is a very concrete way of displaying their “islands of competence” and of highlighting that they have something to offer their world. Involving your child in charitable work is just one possible example. Helping others certainly boosts their self-esteem.

Have realistic expectations and goals for your child. Having realistic expectations provides the child with a sense of control. The development of self-control goes hand-in-glove with self-esteem.

Help your child understand the nature of his/her learning disability. Many children have fantasies and misconceptions about their learning problems that add to their distress (for example, one child said he was born with half a brain). Having realistic information provides that child not only with a sense of control, but also with a feeling that things can be done to help the situation.

The Autism News….According to a report released by the National Center for Health Statistics, approximately one out of every 10 Americans over the age of 12 is taking antidepressants. Women are more than two and a half times more likely to be taking antidepressants than men, with a third of those women taking the antidepressants for 2 – 5 years.

A recent study found that expectant mothers who take antidepressants within the year before their babies are born increase the likelihood that their babies will be born with Autism. The study found that the risk of their babies being born autistic more than doubled for mothers who took antidepressants within a year of birth. For those mothers who took antidepressants during their first trimester of pregnancy, their babies were almost four times more likely to be born autistic than babies born from mothers not taking antidepressants.

by Relly Nadler, M.C.C.     Steve Jobs is a fascinating case study in leadership, because he was a phenomenal innovator and marketer while at the same time being visionary and vicious. He is a star in some EI competencies, but he devastated others on the way to success. Do his ends and accomplishments justify his means?  In the last blog we began to look at the DSM IV criteria for Narcissistic Personality Disorder for Steve Jobs as it helps us understand his motivations and personality. You need 5 of the 9 criteria to meet the diagnosis. It looks like Jobs clearly fits 6 of the 9. We looked at two in the last blog. Here we will explore some of the others.