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:
"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
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
"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
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
Relaxnews/CTV News (December 16, 2015). Retrieved from: http://www.ctvnews.ca/health/cognitive-behavioral-therapy-could-help-treat-seaonal-affective-disorder-study-1.2703560
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.
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
Suicide: Alberta's mental health review will examine the 30% increase in suicides in the province
Alberta government promises to review suicides in wake of 30% increase from last year
(Dec 08, 2015). CBC News. Retrieved from: http://www.cbc.ca/news/canada/calgary/suicide-rate-alberta-increase-layoffs-mental-health-review-1.3355868
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.
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.
"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.
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."
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."
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.
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.
- Suicide rate in Alberta leaps 30% in wake of mass oilpatch layoffs
- 'Palpable paranoia' lingers in Calgary's office towers
- Last person standing: What it's like when the axe falls in your office
"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
"[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.
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
"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.
"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
"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
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
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
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.
Monday, December 7, 2015
Sunday, December 6, 2015
Thursday, December 3, 2015
Monday, November 30, 2015
Clinical and Advocacy: Dementia increasing in Canada, national policy urgently needed to address demand for care
Canada needs a plan to deal with increase in dementia: Editorial
The Trudeau government should use some of its early goodwill to kick-start the process of developing a national plan to address the slow-motion crisis of dementia.
Editorial. (Nov 30 2015). The Star. Retrieved from: http://www.thestar.com/opinion/editorials/2015/11/30/canada-needs-a-plan-to-deal-with-increase-in-dementia-editorial.html
Health experts have been warning for years
that Canada must face up to the growing crisis brought on by a rising
tide of people afflicted with dementia. As the population ages, we will
all be touched – as patients, as caregivers, and as taxpayers.
This is a global problem, as explained over the past 10 days in a series of articles
by Star writers Jennifer Yang, Kate Allen and Amy Dempsey. No country
will be spared, but some will be better prepared than others. And it’s
high time Canadian governments came together and developed a national
strategy to deal with a crisis that will severely challenge both health
care budgets and society as a whole.
We can learn much from looking at the
experience of a country that has aged faster than us and is already
grappling with the issue we will face over the next couple of decades.
In Japan, the world’s first “super-aged” nation, those over 65 already
form a quarter of the population. And, as Yang reported, that country is
pioneering ways to deal with a rising tide of people living with dementia – 4.6 million of them.
The Japanese are training thousands of doctors
on dealing with dementia – from making the right diagnosis to
supporting caregivers. One city, on the outskirts of Kyoto, has
dedicated itself to become a “dementia-friendly” community where people
with the disease can live normally.
Most importantly, as far back as 2000 the
Japanese government introduced mandatory long-term care insurance.
Everyone starting at age 40 must pay into a national insurance fund.
When they turn 65 or are afflicted by an aging-related disease such as
dementia, they can draw on a variety of support services – from daycare
to meal preparation.
Since funding is guaranteed through the insurance plan, that has created a robust market for such services.
It’s far from clear that such a plan could
work in Canada. Social norms are very different in Japan, and our health
care system is run by individual provinces. But it’s the type of big
thinking that is badly needed – but so far sadly lacking – in this
country.
The provinces, including Ontario, haven’t yet
put together an overall strategy for dealing with our aging population.
They still struggle even to provide a bare minimum of home care. And yet
just the cost of treating the 747,000 Canadians with dementia has
already hit $33 billion a year and is rising fast.
The Trudeau government should use some of its
early goodwill to kick-start the process of developing a national plan
to address the slow-motion crisis of dementia. Others are already
leading the way.
More articles from the Star series on dementia:
Star page: http://www.thestar.com/news/dementia.html
Sunday, November 29, 2015
Life transitions: Men, retirement and mental health
Men vulnerable to boredom, depression in retirement
Brenda Bouw (Nov. 26, 2015). The Globe and Mail. Retrieved from: http://www.theglobeandmail.com/globe-investor/retirement/retire-health/men-vulnerable-to-boredom-depression-in-retirement/article27490557/
John McLeod is ready to say goodbye to the
working world. In February, the 59-year-old expects to retire, but
there’s one major flaw in his plan: He isn’t sure how to fill the days
and whether that could affect his well-being.
“I’m
not really going toward anything; I’m just going away from work,” says
Mr. McLeod, who has helped his wife run her real-estate law practice in
Guelph, Ont., since 2000.
Mr. McLeod does a bit of carpentry work,
is an avid reader and member of a local book club, and is planning to
travel with his wife. Still, he sees a major activity gap in retirement.
“My
concern would be that, after six or 12 months or even three years, I’d
be saying, ‘What on Earth am I going to do today?’ That’s where the
concern comes from of either boredom or depression,” says Mr. McLeod.
“I’m not a depressive person, really, but I know it can happen.”
Experts
say men are more susceptible to depression in retirement, in part
because their identity is more closely tied to their careers compared to
women.
“For a lot of men it really is a
loss of a sense of identity – something that we get from work,” said
clinical psychologist Marnin Heisel, director of research and associate
professor in the department of psychiatry at the University of Western
Ontario in London, Ont. He and his colleagues are doing research on men
struggling in their transition to retirement, and are developing a
program to reduce the risk for the onset of depression, hopelessness and
suicide.
While employed, men develop a strong routine and many of their friendships come from work, says Dr. Heisel.
“For
a lot of guys, when they retire, they lose that social network and
social connection … and the meaningful contribution they get out of what
they do.”
A 2012 study
done by Elizabeth Mokyr Horner, a health services and policy researcher
at the University of California, Berkeley, found that male retirees
experience high levels of satisfaction directly after retirement, but
then it falls sharply a few years later.
That was followed by a 2013 study
from The Institute of Economic Affairs that says retirement increases
the probability of suffering from clinical depression by about 40 per
cent. Men also have the highest rates of suicide worldwide, according to
the World Health Organization.
Statistics from the U.S.-based Centers for Disease Control and Prevention show the highest increase in suicide
is in men 50 and over, while suicide rates for men are highest among
those 75 and older. Men 80 and older are the group with the highest
suicide rates in Canada, according to research from the Mood Disorders Society of Canada.
While retirement isn’t always the trigger, experts say the change in lifestyle can be a cause of some cases of depression.
It’s
not the job or the money that men miss so much in retirement, but the
socialization and self-esteem that work brings, says Ken LeClair,
co-chairman of the Canadian Coalition on Seniors Mental Health (CCSMH)
and professor of psychiatry at Queen’s University in Kingston.
“The
best thing that can happen to someone before they retire is that they
hate their job at the end. Those that have loved it and are restructured
out or pushed out have a harder time,” says Dr. LeClair. “If I had a
recipe for good retirement it would be to have a bad job in the last
three working years.”
In a
soon-to-be-released book about men and retirement, Victoria-based author
Lyndsay Green found men have “deeply rooted fears” about leaving the
working world.
That includes loss of
identity after years of defining themselves as the family breadwinner,
and a “profound” attachment to what they do for a living.
“Most
of the men I interviewed like the structure that work gave to their
life and they really like the sense of purpose. … It didn’t matter if
they were the janitor or the CEO. Something they were doing was
contributing to the greater good,” says Ms. Green, whose book is called Ready to Retire? What You and Your Spouse Need to Know About the Reality of Retirement.
Among
the 44 men she interviewed between 56 and 88 – two-thirds of them at
what she calls “peak retirement age” of 64 to 75 – Ms. Green learned the
key to a happier retirement was having “multiple selves,” which means
hobbies and other activities to keep busy. Another key coping mechanism
was to “admit the workplace is going to move on without them.”
Some
men join community groups in retirement to keep busy. One growing trend
in Canada is the “men’s sheds,” a model that started in Australia in
1978 that helps to integrate older men into the community. The sheds,
where men gather to do woodworking, bike repair and other hobbies, were
targeted to men undergoing major life changes such as retirement,
divorce or the loss of a spouse.
Studies have shown
participation decreased self-reported symptoms of depression and
promoted a sense of purpose through relationships and sharing of skills.
A University of Manitoba study, published in the Ageing & Society journal, showed similar results in men who participated.
Mitch Anthony, author of The New Retirementality, says too often men underestimate the need for balance “and the value of work and what work brings to them.”
The old picture of retirement, where every day is like Saturday, doesn’t work for a lot of retirees, says Mr. Anthony.
“When
you don’t have work, your leisure takes on a different meaning. The
reason golf is so much fun to so many people – or whatever their leisure
activity is – is because it means you aren’t at work. When you remove
your work, your leisure becomes work,” Mr. Anthony says. It’s then that
many retirees become bored, and sometimes also depressed.
“The
lie behind the whole retirement model is that our age predicts our
usefulness,” says Mr. Anthony. “It doesn’t matter how much money you
have in retirement, it doesn’t give you purpose.”
Friday, November 27, 2015
Clinical: ADHD, medication and bullying
Teens on ADHD meds are twice as likely to be bullied
At even higher risk are middle and high school students who sell or share medications—they are four-and-a-half times likely to be victimized.
The findings hold true for both boys and girls.
Previous studies have shown that children with ADHD have a harder time making and keeping friends and are bullied and victimized more. The new study, published in the Journal of Pediatric Psychology, is believed to be the first known to look at how stimulant medications affect relationships with peers.
[Bullies who were bullied at risk for suicide]
“Many youth with ADHD are prescribed stimulant medications to treat their ADHD and we know that these medications are the most frequently shared or sold among adolescents,” says Quyen Epstein-Ngo, research assistant professor at the University of Michigan.For the study, researchers surveyed nearly 5,000 middle and high school students over four years. About 15 percent were diagnosed with ADHD and roughly 4 percent were prescribed stimulants within the past 12 months.
Of those who took ADHD meds, 20 percent reported being approached to sell or share them, and about half of them did. When looking at the overall figures, relatively few students were asked to divert their medications or did. However, the numbers don’t tell the entire story, Epstein-Ngo says.
“Having a diagnosis of ADHD has lifelong consequences. These youth aren’t living in isolation. As they transition into adulthood, the social effects of their ADHD diagnosis will impact a broad range of people with whom they come into contact.”
[Can fidgeting help teens with ADHD think?]
From 2003 to 2011, there was a 42 percent increase in ADHD cases diagnosed in the United States, and between 2007 and 2011, there was a 27 percent increase in stimulant-treated ADHD.The findings shouldn’t scare parents away from considering a stimulant medication. Rather, the study reinforces why parents must talk to kids about never sharing their medications.
“For some children stimulant medications are immensely helpful in getting through school,” Epstein-Ngo says. “This study doesn’t say ‘don’t give your child medication.’ It suggests that it’s really important to talk to your children about who they tell.”
It’s unclear why kids with prescriptions for stimulant medications are more at risk for bullying and victimization, but Epstein-Ngo says it’s probably due to several factors.
“Is it a function of the fact that they are in riskier situations, or are they being coerced and forced to give up their medications? Probably a little bit of both.”
The National Institute on Drug Abuse funded the work.
Wednesday, November 25, 2015
Clinical: Loneliness leads to health risks
Health risk of loneliness has physiological basis: study
AFP/CTV News (November 24, 2015). Retrieved from: http://www.ctvnews.ca/health/health-risk-of-loneliness-has-physiological-basis-study-1.2671985
Washington, United States - Loneliness can increase the risk of
premature death by 14 per cent in older adults, according to a study
published Monday that posits a physiological basis for the phenomenon.
The dangers of social isolation have long been known but its effects on the body have not been well understood, the researchers said in the work published in the Proceedings of the National Academy of Sciences/PNAS.
Led by University of Chicago psychologist John Cacioppo, the research team had previously identified a link between solitude and both a heightened expression of genes involved in inflammation and a diminution in the activity of other genes that play a role in the body's antiviral responses.
The result is a weakened immune systems that makes a person who lives alone more vulnerable to illness.
In their latest research, the researchers looked at leukocytes, white blood cells that the immune system uses to protect against bacteria and viruses.
They found the same shift in genetic expression in the white blood cells of people who lived alone and in social isolation.
They also found that loneliness predicted the gene behavior a year or more in advance -- and conversely that gene expression predicted loneliness measured a year or more later.
"Leukocyte gene expression and loneliness appear to have a reciprocal relationship, suggesting that each can help propagate the other over time," the researchers said.
"These results were specific to loneliness and could not be explained by depression, stress or social support," they said.
The investigators then studied rhesus macaques, a highly social primate, and found a similar cellular process linked to their social experience.
"Lonely-like" monkeys had increased gene expression involved in inflammation and less gene expression in antiviral defenses.
They were also found to have higher levels of noreprinephrine, a "fight-or-flight" neurotransmitter that stimulates the production of immature monocytes, a white blood cell with high inflammation/low antiviral defense gene expression.
"Both lonely humans and 'lonely like' monkeys showed higher levels of monocytes in their blood," the researchers said.
Other studies showed that the increased production of immature monocytes was amplifying the high inflammation/low antiviral effect in the pool of white blood cells.
"The 'danger signals' activated in the brain by loneliness ultimately affect the production of white blood cells," they said.
"The resulting shift in monocyte output may both propagate loneliness and contribute to its associated health risks."
The dangers of social isolation have long been known but its effects on the body have not been well understood, the researchers said in the work published in the Proceedings of the National Academy of Sciences/PNAS.
Led by University of Chicago psychologist John Cacioppo, the research team had previously identified a link between solitude and both a heightened expression of genes involved in inflammation and a diminution in the activity of other genes that play a role in the body's antiviral responses.
The result is a weakened immune systems that makes a person who lives alone more vulnerable to illness.
In their latest research, the researchers looked at leukocytes, white blood cells that the immune system uses to protect against bacteria and viruses.
They found the same shift in genetic expression in the white blood cells of people who lived alone and in social isolation.
They also found that loneliness predicted the gene behavior a year or more in advance -- and conversely that gene expression predicted loneliness measured a year or more later.
"Leukocyte gene expression and loneliness appear to have a reciprocal relationship, suggesting that each can help propagate the other over time," the researchers said.
"These results were specific to loneliness and could not be explained by depression, stress or social support," they said.
The investigators then studied rhesus macaques, a highly social primate, and found a similar cellular process linked to their social experience.
"Lonely-like" monkeys had increased gene expression involved in inflammation and less gene expression in antiviral defenses.
They were also found to have higher levels of noreprinephrine, a "fight-or-flight" neurotransmitter that stimulates the production of immature monocytes, a white blood cell with high inflammation/low antiviral defense gene expression.
"Both lonely humans and 'lonely like' monkeys showed higher levels of monocytes in their blood," the researchers said.
Other studies showed that the increased production of immature monocytes was amplifying the high inflammation/low antiviral effect in the pool of white blood cells.
"The 'danger signals' activated in the brain by loneliness ultimately affect the production of white blood cells," they said.
"The resulting shift in monocyte output may both propagate loneliness and contribute to its associated health risks."
Mental Health Services for Refugees Coming to Canada
Refugees to be offered mental health services in Canada
Mark Kennedy (November 24, 2015). Ottawa Citizen. Retrieved from: http://ottawacitizen.com/news/national/refugees-to-be-offered-mental-health-services-in-canada
Some of the Syrian refugees coming to Canada could be afflicted with
mental health problems and will be offered psychological counselling to
help them through their ordeal, says the federal health minister.
Jane Philpott, who chaired the cabinet sub-committee that drafted the government’s Syrian refugee plan, said Tuesday that the initiative has a range of goals.
“One of the guiding principles was what is in the best interest of the refugees,” said Philpott, a Toronto physician who is a first-time MP.
“Obviously we have the health and safety of Canadians in mind. But the health and well-being of refugees was also forefront in our mind.”
In a federal document leaked last week, the government acknowledged that “the influx of a large number of minimally vetted refugees will certainly lead to perceived concerns to the public health of Canadians and the increased risk of infectious disease.”
On Tuesday, federal officials stressed that before refugees leave the Middle East, they will undergo a health check that includes screening for communicable diseases such as tuberculosis. Upon arrival in Canada, there will be another health check.
Philpott said the government is designing the refugee plan so that the migrants move relatively quickly to their host communities from the moment of their arrival in Canada.
Among the questions driving the plan: “How will people adapt well? How will the effects of conflict, the effects of displacement, the effects of travel, the effects of separation of family all be minimized?”
The refugees have escaped a violent civil war in their Syrian homeland and have spent months, perhaps years, in limbo as they live in settlement camps or communities in countries such as Turkey, Lebanon, and Jordan. Many are still living with vivid memories from the conflict that has claimed the lives of more than 200,000 Syrians.
“Mental health concerns are amongst the concerns that we expect to see, of the health concerns of refugees,” said Philpott.
“There is an understanding that counselling services may need to be available and that is part of the traditional refugee settlement package.”
She said refugees will have access to the interim federal health program that provides not just basic insured health services that fall under medicare, but also things like dental and prescription drug coverage.
mkennedy@ottawacitizen.com
Twitter.com/Mark_Kennedy_
Jane Philpott, who chaired the cabinet sub-committee that drafted the government’s Syrian refugee plan, said Tuesday that the initiative has a range of goals.
“One of the guiding principles was what is in the best interest of the refugees,” said Philpott, a Toronto physician who is a first-time MP.
“Obviously we have the health and safety of Canadians in mind. But the health and well-being of refugees was also forefront in our mind.”
In a federal document leaked last week, the government acknowledged that “the influx of a large number of minimally vetted refugees will certainly lead to perceived concerns to the public health of Canadians and the increased risk of infectious disease.”
On Tuesday, federal officials stressed that before refugees leave the Middle East, they will undergo a health check that includes screening for communicable diseases such as tuberculosis. Upon arrival in Canada, there will be another health check.
Philpott said the government is designing the refugee plan so that the migrants move relatively quickly to their host communities from the moment of their arrival in Canada.
Among the questions driving the plan: “How will people adapt well? How will the effects of conflict, the effects of displacement, the effects of travel, the effects of separation of family all be minimized?”
The refugees have escaped a violent civil war in their Syrian homeland and have spent months, perhaps years, in limbo as they live in settlement camps or communities in countries such as Turkey, Lebanon, and Jordan. Many are still living with vivid memories from the conflict that has claimed the lives of more than 200,000 Syrians.
“Mental health concerns are amongst the concerns that we expect to see, of the health concerns of refugees,” said Philpott.
“There is an understanding that counselling services may need to be available and that is part of the traditional refugee settlement package.”
She said refugees will have access to the interim federal health program that provides not just basic insured health services that fall under medicare, but also things like dental and prescription drug coverage.
mkennedy@ottawacitizen.com
Twitter.com/Mark_Kennedy_
Related
Monday, November 23, 2015
Advocacy and Information: Youth Mental Health and Suicide
Rightbyyou.ca
It’s one of the most pressing issues facing our teens today – the lack of support for mental illness and its tragic consequences, such as suicide. 1.2 million Canadian children and youth are affected by mental illness – yet less than one-quarter of them are getting help. Suicide is one of the leading causes of death among our youth.
Let’s open the door so that we can drive more conversations regarding youth mental health, and get our children the help they need.
Bust The Myths
Looking for more information on how to talk about suicide, mental health or mental illness with youth?
Visit the link to check out the videos as experts, parents and youth share their perspectives and bust the most common myths that exist today around this issue.
Web: http://www.rightbyyou.ca/en/bust-the-myths
Get the Guide
Information, resources and tips for parents and caregivers on how to support your teen’s mental health.
Web: http://www.rightbyyou.ca/en/get-the-guide
It’s one of the most pressing issues facing our teens today – the lack of support for mental illness and its tragic consequences, such as suicide. 1.2 million Canadian children and youth are affected by mental illness – yet less than one-quarter of them are getting help. Suicide is one of the leading causes of death among our youth.
Let’s open the door so that we can drive more conversations regarding youth mental health, and get our children the help they need.
Bust The Myths
Looking for more information on how to talk about suicide, mental health or mental illness with youth?
Visit the link to check out the videos as experts, parents and youth share their perspectives and bust the most common myths that exist today around this issue.
Web: http://www.rightbyyou.ca/en/bust-the-myths
Get the Guide
Information, resources and tips for parents and caregivers on how to support your teen’s mental health.
Web: http://www.rightbyyou.ca/en/get-the-guide
Sunday, November 15, 2015
Mental Health Film Night: Deprogrammed - Vancouver, BC
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VANCOUVER PREMIERE! In the 1970s, the youthful search for
meaning could often land you in a cult. As membership in the Moonies, the
Children of God, the Christ Family, the Love Family, the Hare Krishnas, and
others increased, so too did panic amongst middle-class parents, reaching a
fever pitch with the 1978 Jonestown massacre. Into this maelstrom stepped
deprogramming expert Ted “Black Lightning” Patrick, “a 10th-grade drop-out with
a PhD in common sense.” Patrick's “reverse brainwashing” methods were
unorthodox, if not plainly criminal, involving as they did kidnapping, forced
confinement, repetitive interrogations, and sleep deprivation. Mia Donovan
(Inside Lara Roxx) raises questions of the rights of the individual and free
will in this fascinating documentary, which features interviews with the now
84-year-old (and unrepentant) Patrick, never-before-seen archival footage of
deprogramming sessions, and current interviews with former cult members, some
grateful for Patrick’s interventions, some not.
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