Thursday, December 31, 2015

Sunday, December 27, 2015

Clinical: Fetal alcohol spectrum disorder: a guideline for diagnosis across the lifespan

Diagnosing fetal alcohol spectrum disorder: new Canadian guideline

(14 December 2015). Retrieved from: http://www.medicalnewstoday.com/releases/304014.php

 Diagnosing fetal alcohol spectrum disorder (FASD) is important to help children and adults, and their families, who have the disorder. A new Canadian guideline published in CMAJ (Canadian Medical Association Journal), provides recommendations for diagnosing FASD, specifically for multidisciplinary diagnostic teams.

FASD is a neurodevelopmental disorder resulting from prenatal alcohol exposure. Individuals with FASD can experience complex behavioural and intellectual problems that persist throughout the lifespan and can become increasingly complicated if unsupported. The need for early and accurate diagnosis is critical for improving outcomes and quality of life.

It is estimated that 1 in 100 people have FASD, translating to more than 330 000 affected individuals in Canada.

Since the publication of the last Canadian guideline in 2005, research in this area has evolved. The new guideline incorporates updated evidence for detecting and diagnosing FASD across the lifespan.

"These new recommendations, based on the latest evidence for diagnosing FASD, will improve how we diagnose the disorder and help individuals and their families," states Dr. Jocelynn Cook, Canada Fetal Alcohol Spectrum Disorder Research Network and the Society of Obstetricians and Gynaecologists of Canada.

The guideline is aimed at health care providers with specialized training and experience in FASD who are part of multidisciplinary diagnostic teams. Family physicians may find the guideline useful, but the diagnosis must be made with input from other experienced health care professionals.

"The Canada Fetal Alcohol Spectrum Disorder Research Network (CanFASD) played a leadership role in supporting the development of the new Diagnostic Guidelines with funding from the Public Health Agency of Canada. We will continue to support and facilitate research and knowledge exchange on this important initiative," states Audrey McFarlane, Interim Executive Director of CanFASD.

Key recommendations for diagnosis of FASD:
  • Counseling women and their partners about abstinence from alcohol during pregnancy or when planning a pregnancy
  • Screening of all pregnant women and new mothers for alcohol use by trained professionals using tested tools
  • Referring individuals for possible diagnosis if there is evidence of prenatal exposure to alcohol at levels associated with adverse brain function
  • Conducting complete social and medical histories of patients suspected of having FASD
Other recommendations address the sentinel facial features associated with exposure to alcohol during pregnancy, the complex brain injury and differential diagnoses. The guideline includes an algorithm - a decision-making tool - to help multidisciplinary teams diagnose the disorder based on the recommendations.

"Just as diagnosing FASD is important, so too is ensuring the patient and their caregivers receive the support they need to obtain necessary services that may improve quality of life," states Dr. Cook. "They will need specialized support from a team of experts such as child development specialists, occupational therapists, speech-language therapists, psychologists and specialized physician supports, depending on their ages."

For the related online training program "Multidisciplinary Training for Diagnosis of FASD", visit www.canfasd.ca.

The authors note that there are still gaps in understanding of FASD and that ongoing research will continue to inform the field and treatments.

***************************************************************

Fetal alcohol spectrum disorder: a guideline for diagnosis across the lifespan
Jocelynn L. Cook PhD, Courtney R. Green PhD, Christine M. Lilley PhD, Sally M. Anderson PhD, Mary Ellen Baldwin, Albert E. Chudley MD, Julianne L. Conry PhD, Nicole LeBlanc MD, Christine A. Loock MD, Jan Lutke, Bernadene F. Mallon MSW, Audrey A. McFarlane MBA, Valerie K. Temple PhD, Ted Rosales MD; for the Canada Fetal Alcohol Spectrum Disorder Research Network, CMAJ, doi: :10.1503/cmaj.141593, published 14 December 2015.

CMAJ Podcast: Fetal alcohol spectrum disorder: clinical guideline for diagnosis across lifespan

Friday, December 18, 2015

Clinical: CBT helps chronic pain sufferers with sleep

Therapy helps chronic pain sufferers sleep


Thursday, December 17, 2015

Clinical: Cognitive Behavioural Therapy (CBT) effective treatment for Seasonal Affective Disorder (SAD)

Cognitive behavioral therapy could help treat seasonal affective disorder: study


Not many enjoy the shorter days and longer nights that winter brings, but some find it harder than others, developing a form of depression called seasonal affective disorder, also known as SAD. However, researchers have found a new way of treating the seasonal depression with cognitive behavioral therapy.

The traditional method of treating SAD, in addition to antidepressants, is using a light box, a device that emits a 10,000 lux of full-spectrum light to mimic sunlight. Patients are instructed to sit in front of the lightbox daily, usually in the morning, to simulate the sun rising and kickstart the circadian clock.

However, researchers at the University of Vermont also wanted to try a different treatment — cognitive behavioral therapy (CBT) — which, although has been used in depression treatment before, had not been specifically used to treat SAD until now. 

 CBT works by trying to change negative thought processes and break negative attitudes so that the patients feel more positive and empowered.

With regards to SAD, the team wanted to change negative thoughts about winter; so instead of hibernating and avoiding the season, patients could come to embrace it and keep up their social habits and hobbies.
To research the possible benefits of CBT, the team looked at 177 adult participants with major depression that followed the seasonal pattern of SAD.

88 participants were given a six-week course of CBT while the other 89 participants were given a six-week course of light therapy.

All were then followed for one and two winters after the trial had ended, with depression status assessed in December or January by telephone and follow-up visits occuring in either January or February.

The results, published in the American Journal of Psychology, showed that in the first winter after treatment both groups showed large improvements in their SAD; however, there was no difference in this level of improvement between either group, with both treatments equally effective.

However, during the second winter, results showed that only 27.3 per cent of participants relapsed when using CBT, compared with 45.6 per cent of patients using light therapy. Severity of symptoms was also greater reduced in those that had received CBT.

The team concluded that CBT may have been more effective in the long-term because although it takes more work and committment than light therapy, CBT teaches people to change their thoughts, which can help them overcome the condition year after year.

In addition, there was a high rate of non-compliance in the light-box users, with the study finding that less than 1/3 of those in the light therapy group using this treatment one or two winters later. As light therapy is intended for daily use starting in autumn and to be continued until spring, it may be another reason why more effective results were seen with CBT.                                        

Thursday, December 10, 2015

No time limit on grief


Suicide: Alberta's mental health review will examine the 30% increase in suicides in the province

Alberta's suicide rate to be examined in mental health review


Alberta government promises to review suicides in wake of 30% increase from last year


Alberta Health Minister Sarah Hoffman says an upcoming mental health review in the province will include a look at the spike in suicides that some say may be connected to oil and gas layoffs.

There were 252 suicides in Alberta from January to June 2014. During the same period this year there were 327 — a 30 per cent increase. The province's unemployment rate rose from 4.7 per cent to 5.7 per cent during the first six months of 2015.

Hoffman said the numbers are very concerning.

"I hope that the end result is that more people are supported, less people are taking their own life, less people are becoming addicted to substances that often have very tragic outcomes at the end of the day, and that we have more supports and less needs in the long run," Hoffman told reporters Monday.

"But of course the needs are continuing to grow today, and that's one of the reasons why we need to move on having this review."

Hoffman said mental health efforts received a $10-million boost in the provincial budget unveiled in October.

"We're not going to wait until the next budget cycle to get more resources into the hands of community members," she said.

Reducing stigma important


Craig Johnson, who volunteered in the area of suicide prevention for 18 years, says rising numbers place a priority on limiting the stigma around suicide to help encourage more people to come forward for help.

"[We're] trying to get the word out about how we can help each other through times like these," he said.

Mara Grunau, who heads the Centre for Suicide Prevention in Calgary, said the numbers in Alberta are high to begin with.

"More Albertans die by suicide every year than they do in fatal car collisions," she told CBC's Calgary Eyeopener on Monday.

She said one of the main goals should be to talk about suicide to reduce the stigma.

"We want to have open, constructive conversations," said Grunau.

Grunau said the committee behind the mental health review should table a report in early 2016.
Hoffman said Alberta's fentanyl crisis will also be examined in the report, and that she is thrilled the committee expects to meet her deadline of the end of the year.

Minister to pursue more funding


Dr. David Swann, the leader of Alberta's Liberal Party and the member of the legislature for Calgary-Mountainview, is on the committee. He said there is a lot of work underway already, but the review would like to see where the province can fill in the gaps.

"We know there is an increased incidence of depression and anxiety in young people. First Nations have up to seven times as high a rate of suicide and they have much fewer resources," said Swann. "So we do need to beef up the resources."

He said the system has been "fragmented and under-resourced" for a number of years.

The health minister said the $10-million boost will help fix that, and that more funds could arrive next year.
"We will be bringing forward a spring budget, and I will be confident to make a case for why we need to allocate towards mental health," Hoffman said.

She said a look at mental health was among the NDP's campaign promises in the last provincial election.
"I don't think there's any MLA in this house who didn't hear about mental health when they were out door knocking," said Hoffman.

"I think the good news is that people are more comfortable talking about it. The tragic news is that more and more people are being directly impacted — either themselves personally or somebody that they love."

How to help


Cindy Negrello, director of client services at the Canadian Mental Health Association in Calgary, said the spike in suicides could be related to the recession, but most likely has other causes.

"It could be a loss of job, it could be a loss of a pet, it could be a loss of a relationship, it could be loss of friendship — you know, all those different losses — and if they add up, the person's vulnerability would be that much increased," she said.

Negrello said more education is needed to break down the silence around suicide. She would like to see more public discussion.

"We build strength that way," she said. "And then people know, who are feeling isolated and vulnerable, they see more options out there."

Grunau from the Centre for Suicide Prevention agrees. She said sudden changes are a warning sign for someone with depression — if they are suddenly happy, close down their active social media accounts or give away possessions.

"Have the courage to ask them directly: 'Are you thinking of suicide?'" she said. "The worst thing that can happen is they laugh and say no, which is embarrassing, but not a big deal."

She said they often see suicides peak in April — which is around the time experts expect the severance packages from laid-off oilpatch workers to run out.

Anyone looking for help can contact the Calgary Distress Centre.

Stress: How we experience and deal with stress

The Effects of Stress – Are They All in Your Mind?

Most of us have heard and believe that stress has a major negative effect on the body.

But new research shows we need to rethink how important our mind is in determining the effects of stress on our health and energy.

What do you believe? Is stress a debilitating factor in your life or does it somehow enrich your existence – enhancing your health and productivity?

New research shows whatever you believe determines your stress effect.

If you have a negative point of view about what may be considered to be “stressful” it will have a negative effect on you. But if your mindset is positive, “stress” can actually improve your health and effectiveness.

How to Deal with Stress in Seven Steps

You may be surprised by some of these seven steps to relieve stress.

Even if you learn from just one of them, you’ll be much better able to manage those fears, upsets, anxieties, worries and other preoccupations that can take a heavy toll on your mental and physical health.

1. Alter your conversation about stress.

Researchers have known that no event is inherently stressful. What makes one person feel stressed can make another person feel good. Now new studies on the stress “mindset” have made startling new discoveries.

The effects of stress are dependent on what you believe about stress.

Yale researchers found that if you have a negative mindset about stress and believe stress saps your energy and damages your health, then that’s exactly the debilitating effect stress will have on you. No surprise!

But if your stress mindset is positive and you believe stress is a healthy challenge that enhances your
performance and productivity and actually makes you healthier, then that’s the stress effect you’ll experience.

So, if you want to handle stress effectively, the first step is not to label stress as a bad thing. Learn to look at stress with a positive mindset.

2. Cultivate the Pollyanna point of view.

Pollyanna played a game of finding something to be grateful for in every situation. If that seems too difficult, focus on whatever you’re grateful for. An attitude of gratitude is one of the best ways to relieve stress.

3. Develop a genuine sunny disposition.

Studies show that a negative “Debbie Downer” personality, (as opposed to the Pollyanna approach), not only drives others away, but the anxiety actually causes more stressful situations to show up in your life.

4. Start taking more control of your life.

A Harvard study discovered that leaders had significantly lower levels of the stress hormone cortisol and experienced less stress and anxiety.

The research team attributed this discovery to the stress-buffering effect of having a greater sense of control. So step #4 is to take charge of as many things as possible in your life and avoid having a victim mentality.

5. Practice healthy habits and activities.

Make sure you eat healthy, exercise and get enough rest. Also consider relaxation techniques like yoga and meditation, which have been shown to relieve stress. Plus, effective time management helps reduce stress too.

6. Wake up on the right side of the bed.

It should be no surprise that starting your day in a bad mood leads you to feel more stressed. But it has also been shown to cause you to interpret whatever happens to you throughout the day more negatively.

So do whatever it takes to wake up in a good mood, or at least leave your bad mood in bed, no matter which side of the mattress you wake up on.

7. Set aside time to relax and enjoy life.

While developing a positive stress mindset and healthy habits make a huge difference for getting through the more challenging times in life, relaxation, healthy relationships and having fun are also vitally important.

So make sure you set aside time to relax and do the things you enjoy.

Change Your Mind Change Your Stress


To sum it up, these new studies prove that, to a large degree, stress is in the mind of the beholder. If you have a negative stress mindset, you believe stress is detrimental and should be avoided, which is impossible.

But if your mindset is positive, you believe that stress can enhance your performance, increase your energy and actually make you healthier.

By changing your mindset, you reverse any negative stress effects. So once you start to take control over the stress in your life, your mood, productivity, relationships and physical health will all naturally improve.

More Commonsense Health for You:

How to get a Good Night’s Sleep
Secrets of Health from the Healthiest People
Common Sense Health Tips for Healthy Living
The Benefits of Laughter Therapy & Laughter Yoga

References:

Crum, A. J., Salovey, P., & Achor, S. Journal of Personality and Social Psychology. Rethinking stress: The role of mindsets in determining the stress response. J Pers Soc Psychol. 2013;104(4):716-33. doi: 10.1037/a0031201.
Hogh, A., Hansen, Å. M., Mikkelsen, E. G., & Persson, R. Journal of Psychosomatic Research. Exposure to negative acts at work, psychological stress reactions and physiological stress response. J Psychosom Res. 2012;73(1):47-52. doi: 10.1016/j.jpsychores.2012.04.004.
Rothbard, N. P., & Wilk, S. L. Academy of Management Journal. Waking up on the right or wrong side of the bed: Start-of-workday mood, work events, employee affect, and performance. Acad Manage J. 2011;54(5), 959-980. doi: 10.5465/amj.
Gleason, M. E. J., Powers, A. D., & Oltmanns, T. F. Journal of Abnormal Psychology. The enduring impact of borderline personality pathology: Risk for threatening life events in later middle-age. J Abnorm Psychol. 2012;121(2):447-57. doi: 10.1037/a0025564.
Chu, K. H., Baker, M. A., & Murrmann, S. K. (2012). International Journal of Hospitality Management. When we are onstage, we smile: The effects of emotional labor on employee work outcomes. Int J Hosp Manag. 2012;31(3),906-915. doi: 10.1016/j.ijhm.2011.10.009

Petersen H, Kecklund G, D’Onofrio P, Nilsson J, Åkerstedt T. Journal of Sleep Research. Stress vulnerability and the effects of moderate daily stress on sleep polysomnography and subjective sleepiness. J Sleep Res. 2013;22(1):50-7. doi: 10.1111/j.1365-2869.2012.01034.x.

Tuesday, December 8, 2015

Clinical: Motivational interviewing decreases risk for opioid misuse and increases positive behaviour change

Empathetic chats lower risk of painkiller abuse



Prescription opioid abuse has reached epidemic proportions among baby boomers, with more than half the patients being treated for chronic pain reportedly misusing their medication at some point.

However, new research shows that “motivational interviewing,” a form of behavioral counseling, is an effective tool at curbing the abuse.

Prescription opioids—which include pain medications such as morphine, Lortab, and codeine—are abused by 1.9 million Americans and cause nearly two deaths every hour from overdose or respiratory depression.

Further, nearly 75 percent of opioid addiction patients switch to heroin as a cheaper source of the drug, according to data from the American Society of Addiction Medicine (ASAM).

“Older adults are at high risk for complications resulting from prescription opioid misuse,” says Yu-Ping Chang, associate professor at the School of Nursing at the University at Buffalo. “As the baby boomer generation ages and more patients are prescribed opioids, abuse is likely to become an even greater problem.”
[Drug abusers double up on heroin, painkillers]
Motivational interviewing (MI) is designed to promote a patient’s desire to change problem behaviors by expressing empathy for their experiences, using non-confrontational dialogue, and developing discrepancies between actual and desired behavior.

Although it was developed to treat alcohol abuse, researchers wondered if the intervention also could be effective in treating opioid misuse in older adults.

259 million prescriptions


For the study, published in the journal Perspectives in Psychiatric Care, researchers examined patients 50 years of age and older who experienced chronic pain and were rated at risk for opioid misuse based on screening tools. The participants underwent MI for one month, which consisted of an in-person meeting followed by weekly phone sessions with counselors, and, later, a one month follow-up test.

Before and after the intervention, participants completed screening surveys for risk of opioid misuse, alcohol abuse, levels of motivation, self-efficacy, depression and anxiety, chronic pain intensity, and treatment satisfaction.
[Many ER patients don’t know that painkillers are addictive]
In addition to reducing the risk for opioid misuse, participants reported an increase in confidence, self-efficacy, and motivation to change behavior, and a decline in depression, anxiety, and the intensity of chronic pain.

The success of the low-cost intervention is a positive sign in the battle against prescription opioid abuse in primary care, Chang says.

Opioids are one of the most commonly prescribed medications used to treat individuals with chronic pain, an issue that affects nearly half of Americans at some point in their lives. In 2012 some 259 million opioid pain medication prescriptions were written, enough for every adult in the US to have a bottle of pills.

“Primary care providers who prescribe opioids to their patients with chronic pain are in the unique position to identify and intervene with patients whose use is hazardous or harmful to their health,” Chang says. “With motivational interviewing techniques, a brief and practical behavioral intervention, they can reduce the risk of opioid misuse and abuse.”

Risk factors that could lead to opioid abuse include social isolation, poor health, multiple chronic illnesses, mental illness, and prior or current substance abuse. Health care providers should assess these factors when treating chronic pain patients, Chang says.

Future research will explore the long-term effects of motivational interviewing, and incorporate additional patient testing measures, such as pill counts, refill records, and urine drug tests, says Chang.

Source: University at Buffalo

Monday, December 7, 2015

Music...


Intervention: Meals on Wheels nourishes and decreases loneliness for older adults

Meals on Wheels brings food and cuts loneliness


Sunday, December 6, 2015

Research: Reactions to stress and health

Health may hinge on being cheerful during stress