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09 Sep

Rarely does addiction occur in a vacuum. Often times the pull of addictive substances or a genetic predisposition to substance use disorder are complicated by a person’s mental health history. When people are dealing with both substance use disorder and mental illness, they are said to have a dual diagnosis, also referred to as co-occurring disorders. 

Being well-informed about co-occurring disorders can help you (or your loved one) connect with the treatment that you need to heal. Getting into the right recovery program that can help you manage both conditions reduces your risk for relapse and helps you stay sober in the long-term. 

12 Things You Should Know About Co-Occurring Disorders:

1. They’re important to know about. 

Many people with substance use disorder are self-medicating underlying mental health conditions like depression or anxiety. Because of this, it’s very common for individuals to have both substance use disorder and mental illness. Knowing about, diagnosing, and treating both conditions is instrumental for recovery.

2. They’re super common.

Substance use disorder and mental illness often go hand in hand, and both conditions are extremely common. Nearly 8 million Americans are living with co-occurring substance use disorder and a mental health condition at the same time, according to the National Alliance on Mental Illness.

3. People with mental illness often turn to illicit drugs.

Many people with mental illness lack the resources to access care for their condition. In many cases, this leaves them turning to illicit drugs or abusing drugs or alcohol in order to self-medicate their condition. About one-third of all people with a mental health condition and half of people with serious mental illness have co-occurring substance use disorder.

4. Understanding of co-occurring disorders has increased.

Health professionals used to think that substance use disorder was a moral failing, and that mental health conditions like depression or schizophrenia were caused by moral weakness or bad parenting. However, understanding of both conditions has advanced rapidly, with science providing more information on co-occurring disorders.

5. Evidence-based treatment is available.

Today, there are evidence-based treatments for both substance use disorder and mental illness. Using medication and therapy, people with dual diagnoses can make great progress in managing their conditions.

6. Both conditions must be treated.

In the past, doctors thought that substance use disorder had to be rectified before a person could get treatment for their mental illness. However, today most health care providers recognize that the best outcomes occur when both conditions are treated simultaneously. This is called integrated treatment.

8. They require special care.

While it’s entirely possible to live a healthy life with a dual diagnosis, treating mental illness and substance use disorder can be tricky. That’s because some medications used to treat mental illness have the potential to be abused. It’s important that people with dual diagnoses connect with a treatment professional who can help them develop a medication management plan that addresses both conditions.

9. Substance use can contribute to mental health conditions.

Trying to figure out which condition came first can be a chicken and egg situation. However, research shows that some substance use can contribute to mental health complications. For example, there are some cases where early marijuana use has been linked with an increased risk for psychosis in adulthood.

10. Stress makes them worse.

Both mental illness and substance use disorder are made worse when a person is stressed. That’s because stress changes how the brain functions: For example, stress reduces the functioning of the prefrontal cortex which helps people make rational decisions, and increases activity in the striatum which can lead to more impulsive behavior, according to the National Institute on Drug Abuse.

11. Genetics and environment play a role.

Genetic factors can increase a person’s risk for both substance use disorder and mental illness. For example, scientists believe that 40-60 percent of a person’s risk for substance use disorder can be explained by genetics. The rest is determined by epigenetic and environmental factors, like childhood trauma. 

12. Early intervention is important.

Teens who have co-occurring substance use disorder and mental illness benefit greatly from early intervention. Connecting teens with treatment that understands dual diagnoses can help them learn to manage both conditions without either getting to the point of crisis.

13. Support is available.

People with dual diagnoses can find help from traditional recovery programs, but they might also benefit from involvement with programs that are specifically designed for people with co-occurring disorders. Double Trouble in Recovery is a 12-step program for people with co-occurring disorders. 

Learn more about Oceanside Malibu at http://oceansidemalibu.com/. Reach Oceanside Malibu by phone at (866) 738-6550. Find Oceanside Malibu on Facebook.

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25 Aug

In an interview with NeurologyLive, Michael Thorpy, MBChB, spoke about the challenges of diagnosing narcolepsy and the implications for a multimodal therapy approach.

Cataplexy is very difficult to diagnose. Some patients laugh and fall to the ground, in which case it’s easy to diagnose. But some patients have subtle evidence of cataplexy; even the patient may not be aware that they’re having it. It may be noticed by other family members and might be just a little bobbing of the head, or the head coming down, the eyelids coming down, flattening of the face, or sometimes it’s a little dysarthria—patients speaking and the voice becomes slurred. They can be very subtle, and for that reason it’s often missed and that adds to this delay in diagnosis of narcolepsy.

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01 Aug

From left to right: Nolan R. Williams, M.D., Erin S. Calipari, Ph.D., Dorothy Schafer, Ph.D., and Herbert Pardes, M.D.

New York, Aug. 01, 2019 (GLOBE NEWSWIRE) — The Brain & Behavior Research Foundation has announced the winners of its 2019 Klerman and Freedman Prizes recognizing exceptional clinical and basic research in mental illness. The prizes are awarded annually to honor the work of outstanding scientists who have been supported by the Foundation’s Young Investigator Grants Program. The grants program provides funding for research that impacts all brain and behavior disorders. 

The awards were presented at a ceremony in New York City on July 26, the evening before the annual meeting of the Brain & Behavior Research Foundation Scientific Council. The group of 180 leading experts across disciplines in psychiatric research meets to discuss grant applications and recommend the most promising ideas to fund.

Dr. Herbert Pardes, President of the Scientific Council, presented the awards and noted, “The Klerman and Freedman prizes recognize innovative thinking and remarkable talent across the field of neuropsychiatry. Recognition for scientists early in their career helps them go on to receive further funding and is a precursor to further accomplishments.  We applaud these researchers for their brilliant work, and we thank our generous donors who understand that support of brain and behavior research will continue to produce better treatment, and ultimately, cures and prevention for mental illness.”

The Young Investigator Grant Program enables scientists who are early in their careers pursue innovative ideas in neurobiological and psychosocial research, gather pilot data and generate “proof of concept” for early detection, treatment, prevention and cures for mental illness.

Dr. Jeffrey Borenstein, President and CEO of the Brain & Behavior Research Foundation, said, “Since our Foundation was established in 1987, we have awarded more than $394 million to more than 4,700 scientists in 35 countries, and we have seen significant progress that has changed the lives of people living with mental illness. The exceptional work of these BBRF Young Investigators keeps us moving forward toward a future in which all people living with mental illness will be able to lead full, productive and healthy lives.”

The Klerman and Freedman Prizes are named for Gerald Klerman, M.D., and Daniel Freedman, M.D., neuropsychiatry pioneers who played seminal roles as researchers, teachers, physicians and administrators.   

This year six scientists received recognition for their outstanding work in brain and behavior research. They are:

2019 Klerman Prize for Exceptional Clinical Research

Nolan R. Williams, M.D., Assistant Professor, Director Brain Stimulation Lab, Director, Interventional Psychiatry Clinical Research, Stanford University, Wu Tsai Neurosciences Institute, Stanford Bio-X

Themes of Dr. Williams work include examining the use of spaced learning theory in the application of neurostimulation techniques, development and mechanistic understanding of rapid-acting antidepressants, and identifying objective biomarkers that predict neuromodulation responses in treatment-resistant neuropsychiatric conditions.

2019 Freedman Prizewinner for Exceptional Basic Research

Anna Victoria Molofsky, M.D., Ph.D., Associate Professor, University of California at San Francisco, Department of Psychiatry and Weill Institute for Neurosciences

The Molofsky lab studies synapses – the essential connections between the nerve cells in the brain. In particular, the lab investigates the role of the immune system in helping synapses to form properly. While the immune system plays many healthy roles in the brain, inflammation caused by infection and brain injury can also increase the risk for some mental illnesses, including autism spectrum disorders, schizophrenia and depression.

2019 Klerman Prize Honorable Mention

Bo Cao, Ph.D., Assistant Professor, Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton

Dr. Cao is developing translational tools for accurate and personalized diagnosis and treatment optimization for mental disorders (including major depression disorders bipolar disorders, schizophrenia and substance misuse). 

2019 Klerman Prize Honorable Mention

Sarah A. O. Gray, Ph.D., Assistant Professor, Department of Psychology, Department of Psychiatry and Behavioral Sciences, Tulane University

Dr. Gray ‘s research examines the developmental consequences of early life adversity, with a specific focus on intergenerational processes.

2019 Freedman Prize Honorable Mention

Erin S. Calipari, Ph.D., Assistant Professor, Department of Pharmacology, Department of Molecular Physiology and Biophysics, Department of Psychiatry and Behavioral Sciences, Vanderbilt Center for Addiction Research

Dr. Calipari’s most recent work focuses on how sex differences in processes within the brain make women particularly vulnerable to substance use disorder.

2019 Freedman Prize Honorable Mention

Dorothy Schafer Ph.D., Assistant Professor, University of Massachusetts Medical School

Dr. Schafer’s lab investigates the role of microglia in regulating neural circuit structure and function. 

About the Brain & Behavior Research Foundation

BBRF awards research grants to develop improved treatments, cures, and methods of prevention for mental illness. These illnesses include addiction, ADHD, anxiety, autism, bipolar disorder, borderline personality disorder, depression, eating disorders, OCD, PTSD, and schizophrenia. Since 1987, the Foundation has awarded more than $394 million to fund more than 4,700 leading scientists around the world, which has led to over $3.9 billion in additional funding. 100% of every dollar donated for research is invested in our research grants. The Foundation’s operating expenses are covered by separate foundation grants.

  • BBRFScientificCouncil2019 – 292
Myrna Manners
Brain & Behavior Research Foundation
(718) 986-7255

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26 Jul

Saskatoon man Brian Kim says he unknowingly had narcolepsy for 20 years, reports CBC News.

For years, Kim failed to meet the threshold for in-hospital sleep testing for sleep apnea. Finally, with his symptoms getting worse over time, he got his date with an overnight sleep test.

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24 Jul

The research included 432 adolescents who were 11 to 17 years old and who are part of the larger ongoing Adolescent Health and Development in Context study, a longitudinal research project looking at the impact of social and other factors on health. That project is led by Christopher Browning, a sociology professor at Ohio State who is also a co-author of the cortisol and depression study.

For the cortisol study, the researchers measured depression with a nine-item questionnaire that the participants filled out. They were asked to rate their experience in a variety of areas, including how often they feel that their life has been a failure or that people have been unfriendly to them.

In most cases, the researchers examined a 3-centimeter hair sample – enough to assess cortisol levels for the previous three months.

After adjusting the results for a variety of potential factors that could contribute to depressive symptoms and to cortisol levels, the researchers found the surprising trend that both low and high cortisol had a statistically significant relationship to depression.

Nearly one in eight adolescents have experienced a major depressive episode, according to 2016 data, and the proportion of young people facing depression has steadily increased in the last decade. Suicide is the second leading cause of death among adolescents.

But children and teens can struggle to describe their symptoms, and parents and others can miss warning signs if they mistake serious mental health problems for the normal turbulence of puberty, Ford said.

“It’d be really ideal to have an objective measurement, because using subjective measures of stress is problematic, particularly with children and teens,” she said.

Testing is simple, and relatively cheap (on the order of about $35), but it won’t be something to consider for widespread use until researchers better understand what values are normal and what values are out of range and cause for concern, Ford said.

It’s possible that cortisol testing could serve not just as a detection tool, but as a way to watch over time to see if therapy and medication are helping someone with depression, or if the mental illness is intensifying and putting the adolescent at risk of suicide, she said.

Next, Ford would like to conduct a longer, larger study looking at adolescent depression and cortisol levels over time.

Samantha Boch of Nationwide Children’s Hospital also worked on the study.

The National Institutes of Health supported the research.

For help, contact the National Suicide Prevention Lifeline at 1-800-273-8255/TALK (or 1-888-628-9454 for Spanish speakers). To reach someone at Ohio’s 24/7 Crisis Text Line, send 4HOPE to 741741. 

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09 Jul

Who decides whether you’re clinically depressed or anxious, suffering from schizophrenia or living with a trauma-related disorder? In the UK, GPs diagnose milder forms of depression and anxiety but psychiatrists make the call when it comes to more severe and protracted forms of mental ill health. In the US, the handbook that sets out the criteria for diagnosis is the Diagnostic and Statistical Manual of Mental Disorders, now in its fifth incarnation (DSM-5). In Europe, the broadly similar WHO International Classification of Diseases (ICD) is more commonly used.

But a new study from the University of Liverpool has analysed five key chapters of the DSM-5 on schizophrenia, bipolar disorder, and depressive, anxiety and trauma-related disorders and found so much scope for variation that the authors question whether diagnosing distinct mental health disorders such as schizophrenia is valid or helpful at all.

The authors point out that psychiatric diagnoses all use different decision-making rules, symptoms such as agitation are common to several diagnostic labels, diagnoses don’t reflect the role of trauma or adverse events, and, most importantly perhaps, a diagnosis says little about an individual person and which treatment approach may be helpful. The current system of diagnostic labelling may represent “a disingenuous categorical system”.

Lead researcher Dr Kate Allsopp says: “Although diagnostic labels create the illusion of an explanation they are scientifically meaningless and can create stigma and prejudice.” She hopes these findings will encourage mental health professionals to think beyond diagnoses and consider other explanations of mental distress, such as trauma and other adverse life experiences. And her colleague and co-author, Prof Peter Kinderman, adds: “This study provides yet more evidence that the biomedical diagnostic approach in psychiatry is not fit for purpose. Diagnoses frequently and uncritically reported as ‘real illnesses’ are in fact made on the basis of internally inconsistent, confused and contradictory patterns of largely arbitrary criteria. The diagnostic system wrongly assumes that all distress results from disorder, and relies heavily on subjective judgments about what is normal.”

So are specific diagnoses for mental health conditions defunct? Or do people in the depths of mental distress find some relief in having a concrete label and plausible reason for their anguish? Is getting a diagnosis stigmatising and reductive? Or does it provide a framework for treatment, protection in law against discrimination and a requirement for authorities to provide support?

Psychiatrist Prof Simon Wessely says that this latest salvo is part of a long-standing dispute between academics who are “strongly against the diagnoses we use and the treatments we use and don’t give the impression of being too keen on psychiatry and psychiatrists in general”. Diagnosis in psychiatry is always a work in progress; it’s not like diagnosing thyroid disease on the basis of a blood test. “But a diagnosis is just the start of ongoing encounters (between patients and psychiatrists) and doesn’t preclude a much more complex formulation of their individual needs.”

Wessely says the DSM-5 is used in the US because the insurance companies won’t pay up without a diagnostic category. In the UK, where 90% of mental health problems are seen by GPs and where you don’t need a label to qualify for treatment, the DSM-5 is rarely used. As a GP, I must say that I’ve never seen a copy, let alone used one.

But it’s quite a leap from pointing out the inconsistencies and limitations of a handbook to rejecting the whole notion of diagnosis. Wessely says that diagnosis is essential to the practice of medicine; “anorexia is not the same as schizophrenia” and different conditions require different therapeutic approaches. Clinical trials to identify and test new treatments would be impossible without some standardisation of diagnostic criteria. “In 50 years’ time, we’ll be using different criteria, but there will still be criteria,” he predicts.

Allsopp and Kinderman have previously written in the Lancet that instead of recording a diagnosis of, say, “moderate personality disorder”, clinicians could record the series of adverse events and mental health difficulties that the person is experiencing, such as personal history of sexual abuse, partner violence and low income which lead (understandably) to anger, depressed mood and self-injury. This avoids “unnecessary pathologisation” and could lead to better clinical services.

Back in my day job as a GP, I wonder what purpose is served by this over-heated “debate” about diagnosis v non-diagnostic formulations. At least half of the people I see have a primary mental health problem and there’s a psychological component to every single interaction that I have with patients, even if they’ve come in with a physical problem. Sometimes a label is useful, sometimes it isn’t. There’s no debate about whether or not it’s OK to say that your abdominal pain is caused by gallstones; obviously the diagnosis is just a starting point in formulating a plan of action that is acceptable to patient and doctor alike. Diagnosing schizophrenia should be like gallstones: a starting point for action to alleviate suffering and improve wellbeing.

But I get what Kinderman says too: a diagnosis is a one-word intro, it’s not the story. Doctors, patients and families can all become distracted by the label and forget what’s inside. People are never “a diabetic”, “a schizophrenic” or “a manic depressive”. Everyone knows that but it’s easy to forget. Kinderman et al may overstate their case, but it’s a useful corrective to our over-medicalised approach.

Ann Robinson is a GP

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