Once again, the time has come to bid farewell to an intern class. Our 2016-2017 interns are officially loose in the world, to do all the good they can do–which I believe will be an amazing amount.
Congratulations, ladies. YOU DID IT!!
Dr. Vaught and the WKPIC Supervisors and Instructors
<Discussion is not an endorsement, for informational purposes only>
Project Daris is a free resource that came out of a heartbreaking tragedy. Project Daris was started by the parents of Daris Fent, a talented young man with a bright future who tragically lost his life to a heroin overdose. Daris was an accomplished guitarist, an excellent student, was well-liked among his peers, and after graduating high school he became a Marine. By all accounts, he was just a good young man with a goal of helping others. Sadly, he developed an addiction to prescription Oxycontin due to an injury sustained while in the military; he was able to hide his addiction for several years, until he had no other option but to ask for help. He attended rehab, and initially was successful in beating addiction. However, he relapsed in less than 30 days, and it was during the relapse that he overdosed.
It was from this tragedy that his parents set up Project Daris to help prevent what happened to Daris from happening to others. Consisting of a group of healthcare professionals that includes doctors, pharmacists, and nurses, Project Daris provides free substance abuse prevention education to grades K-12 in Kentucky with the goal of reaching children in all 120 counties. Project Daris provides age appropriate materials to all age groups, and where appropriate and permissible for grades 6-12, people in long term recovery are brought in to share their stories. The program can address a classroom or an entire school, and considering that 1 in 4 middle and high school students admit to having abused drugs, the earlier education is shared concerning the dangers of drug abuse and addiction the better. The program takes about an hour for a full presentation, is 100% free due to being privately funded by concerned healthcare professionals, and is a unique educational opportunity for students.
For further information, or to schedule a visit, please contact Dr Robert Goforth Pharm.D, RPh., at robert@projectdaris.com.
Teresa King
PMHC Intern
Suicide and suicidal ideation have recently been brought to the fore of the public consciousness by way of a popular teen show called “13 Reasons Why”. Although I view this show as an absolute trainwreck due to the nature of the subject matter and how it is portrayed by the producers of the show, it has opened up a bit of a dialogue by touching on a subject that is extremely sensitive, often misunderstood, and difficult to broach as a topic of conversation. While suicide is complicated and tragic, it is also often preventable when the signs that signal its impending occurrence are recognized and help is sought. Over 40,000 people die by suicide in the US each year, making it a serious public health concern as the 10th leading cause of death overall.
The signs of suicidal ideation aren’t difficult to recognize, as there is a particular list of behaviors that tend to be early warning signals that someone is contemplating the taking of their own life in a serious way. Someone who is contemplating seriously contemplating suicide may talk openly about feeling hopeless, having no reason to live, or wanting to die or kill themselves. They may confide that they are in unbearable emotional or physical pain, dealing with tremendous guilt or shame, or feeling trapped in a hopeless situation or circumstance with no solution or way out other than death. Many times they will even reveal that they are working on a plan or looking for a way to commit suicide. They may begin using alcohol or drugs as a coping mechanism, or increase the use of same if they are already users. People with suicidal ideations often talk of being a burden on others, such as loved ones, friends, or coworkers, and may act anxious/agitated while slowly withdrawing from friends and family. Noticeable changes in eating or sleeping habits, showing rage, talk of “seeking revenge”, or taking unnecessary risks that could be fatal, such as driving recklessly, are often indicators of suicidal ideation, and may or may not be accompanied by displays of extreme mood swings. Someone who is contemplating the taking of their own life may be talking or thinking about death constantly, and they may prepare for the final act by saying goodbye to family and friends, giving away important possessions, or by getting their affairs in order and making a will or some other legal document as to the final disposition of their estate. While these criteria may not necessarily be indicators of suicidal ideation in and of themselves singularly, you should seek help as soon as possible if these warning signs apply to you or someone you know plurally, especially if the behavior(s) are new or have recently increased in frequency.
There are several risk factors and indicators that may signal if someone is contemplating suicide, and it is important to realize that suicide is non-discriminatory. Anyone of any gender, age, or ethnicity can be a suicide risk. The behaviors associated with suicide are complex, with no single cause; many different contributing factors are present for someone who attempts to take their own life. However, those most at risk do tend to share certain risk factors for suicide:
Many people often have some of these risk factors, but do not attempt suicide or display suicidal ideations. This is because suicide is not considered to be a normal response to stress; thoughts or actions of a suicidal nature are a sign that someone is in extreme distress requiring immediate intervention and assistance. When suicidal ideations or actions are displayed by someone, it should not be ignored, or written off as a harmless bid for attention. Friends and family are usually the first to recognize the warning signs of suicide, and are usually in the best position to assist with helping someone who is at-risk find the specialized treatment that will be required to address the diagnosis and treatment of the mental health conditions that are the root of the problem.
The demographics of suicide with regard to race/ethnicity, age, and gender as related to risk are interesting. Women are more likely than men to attempt suicide, but men are more likely to actually be successful in the attempt due to a predilection for choosing deadlier methods such as firearms or suffocation, where women show a preference for suicide by poisoning. Women are most likely to attempt suicide between the ages of 45 and 64, while men peak at ages 75 and up. In younger people, suicide is the second leading cause of death in the 15 to 34 age range. Native American Indians, as well as Alaskan Natives, tend to have the highest rate of suicides among ethnic groups, just ahead of non-Hispanic whites, while African Americans trend toward the lowest rate of suicide, with Hispanics at the second lowest rate.
If you recognize the signs of suicidal ideation/contemplation and want to offer assistance, there are 5 steps you can take to assist someone who is at a suicidal level of distress. The first thing to do is to ask “Are you thinking of killing yourself?” A tough question, yes, but asking it hasn’t been shown to increase suicides or suicidal thoughts. Secondly, keep them safe by reducing or preventing their access to lethal items or places. This is an important aspect of suicide prevention, along with asking if they have a plan for their suicide and then removing or disabling the lethal means to complete their plan. The third step involves listening carefully to ascertain what the person is thinking and feeling. Talking about and acknowledging suicide may actually decrease suicidal thoughts and ideations. Next, assist them with reaching out and making a connection. The National Suicide Prevention Lifeline at 1-800-273-8255 (TALK), or a trusted family member, friend, or mental health professional can help make all the difference in assisting them with getting the help they so desperately need to overcome their crisis. Finally, stay in touch after the crisis. Studies have proven that someone following up with an at-risk individual after they’ve been discharged from care reduces their risk of recurrence.
The ability to get immediate help for someone who is contemplating suicide is critical; instant access to emergency numbers can mean the difference between saving a life and losing one. The non-emergency number to the local police department, the number of a trusted friend or relative, the Crisis Text Line at 741741, and the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) should be saved for quick retrieval in your cell phone, along with any other local emergency numbers. Being able to summon immediate help can make a difference.
It should also be noted that social media can and does play a large and ever-increasing role in people’s day to day lives, and occupies an important niche in many people’s social interactions with others. If you recognize the signs and indicators of suicide or suicidal ideations in the posts of someone on social media, reach out to them, or contact the social media site directly if you notice concerning updates.
SOURCES
Suicide Prevention. (2017, March). Retrieved June 9, 2017, from
https://www.nimh.nih.gov/health/topics/suicide-prevention/index.shtml
Teresa King
PMHC Intern
As a doctoral psychology intern I have noticed that many clients are being ordered to have genetic testing to assist the physician to determine the proper diagnosis as well as what medication may be more appropriate. It has been relatively recently that research has been initiated on the MTHFR gene, as well as the enzyme it produces, and the effects caused by its malfunction. MTHFR stands for MethyleneTetraHydroFolate Reductase, and its acronym is used interchangeably to denote either the gene or the enzyme it produces. The gene is found on the short arms (there are 2- 1 each from the mother and father) of Chromosome 1. The gene is made up of 20,373 base pairs, and the MTHFR enzyme produced by the MTHFR gene helps to produce pyrimidines, which are the building blocks of DNA nucleotides.
When the MTHFR gene is mutated, the enzyme it produces is not entirely correct. These mutations tend to be very small and minor; however, they can create a variety of health problems and issues. For the enzyme to work properly it has to be perfect since even the smallest mutation of the gene sequence can produce severe chronic health effects. 0.000098% is the threshold for mutation, or just 1 mistake in the 20,373 steps of the MTHFR gene code.
The most common mutations are found at positions 677 and 1298 on the MTHFR gene, with the mutation being capable of affecting one, the other, or both positions. It should be understood that MTHFR gene mutations can cause absolutely no symptoms at all, or they can cause severe, irreversible issues like Down’s syndrome, pulmonary embolisms, and Parkinson’s. While research is ongoing in an attempt to determine exactly which conditions are caused by or attributable to mutations of the MTHFR gene sequence, it has been determined that there are quite a few medical conditions and syndromes that are related to mutations in the MTHFR gene sequence. A partial list:
While this list is not all inclusive, it does reveal the depth of the importance of testing to determine if MTHFR mutations have occurred, the particular location of the mutation, and what treatment protocols should be considered with regard to the expressed health issue. For more complete and in-depth info, please go to http://www.mthfr.net for the latest research on MTHFR and its associated effects on health.
Sources
Lynch, B., MD. (2012, January 25). MTHFR Mutation. Retrieved June 12, 2017, from http://mthfr.net/
Teresa King
PMHC Intern
While the suicide rate in America trended steadily and solidly downward during the ‘80s and ‘90s (likely attributable to new, more effective antidepressants with fewer side effects), a significant turnaround with an increase was noted between 1999 and 2014 (Bichell, 2016), with some fluctuation between 1999 and 2007; from 2007 onward, however, the rates rose sharply with a particularly marked increase in the rates of children aged 10-14 (Middlebrook, 2016). While it is true that suicide rates climbed steadily in the 15 years from 1999 to 2014 for every age group under 75, the one demographic that stands out most is young girls ages of 10 to 14. Of particular concern is the fact that while they are a very small percentage of total suicides, their group experienced the most dramatic increase, with rates actually tripling over 15 years from 0.5 to 1.7 per 100,000 people (Bichell, 2016). While this is quite an alarming trend, the fact that there are nearly 400 attempts for every completed suicided raises the stakes to an even higher degree (Cutler, Glaeser, Norberg, 2001).
A singular cause has been difficult to pin down: a difficult economy, with attendant joblessness/unemployment making it more difficult to access health care and/or treatment; lack of appropriate coverage under personal health insurance policies; and a shift in the drug of choice among recreational users from crack and cocaine to heroin and prescription narcotics (Bichell, 2016). A positive correlation between suicide and homicide was noted, as was the fact that while girls attempt suicide more often than boys, it is the boys who complete it more often. Blacks have lower rates of attempts and completions than whites, rural states have higher rates of suicide, and firearms are by far the most utilized method in successful suicides (Cutler, et al, 2001).
The reasons behind the “why” of youth committing suicides are equally difficult to ascertain. Rationalization of the act in the context of an unhappy life that has less value than death, as well as an attempt to exert some measure of control in the face of feeling helpless/powerless or to elicit a response (“looking for attention”) have been positively identified, as has the combination of impulsive behavior and availability of firearms or other equally accessible methodology; or even, incredibly, imitating the suicide of a close friend or loved one (Cutler, et al, 2001). Earlier puberty has also been advanced as a possibility, due to so much change occurring all at once. While boys tend to peak around 13, with girls the peak age of puberty drops to 11, with some studies indicating that girls may be starting their periods even earlier. It has also been shown that there is a direct correlation between the onset of puberty and the onset of psychological disorders, particularly depression, which is a huge risk factor for suicidal ideations, and due to the shift in the age of onset for puberty, girls may be experiencing a myriad of psychological issues in addition to anxiety and depression at a much younger age than ever before encountered (Bichell, 2016).
This recent trend toward an increase in suicidal ideation, attempts, and completions is disheartening, to be sure, but it can be corrected. Parents absolutely must look to their children’s welfare, and be attentive to the needs of their children. While they should definitely talk to their children regularly to ascertain the presence, if any, of issues that may be of serious concern, parents should also be ready to just listen, and let their children talk without being pressured. There are many issues faced by children that parents too often tend to forget from their own childhood, and the unavailability of parental support and reassurance can be a contributing factor in allowing children to slip towards an irreversible event that can be readily avoided.
References
Bichell, R. E. (2016, April 22). Suicide Rates Climb In U.S., Especially Among Adolescent
Girls. Retrieved May 10,
2017, from http://www.npr.org/sections/health-shots/2016/04/22/474888854/suicide-rates-climb-in-u-s-especially-among-adolescent-girls
Cutler, D. M., Glaeser, E. L., & Norberg, K. (2001, March 15). Explaining the Rise in Youth Suicide. Retrieved May 10, 2017, from https://papers.ssrn.com/sol3/papers.cfm?abstract_id=263440
Middlebrook, H. (2016, November 03). Suicide deaths on the rise in kids. Retrieved May 10, 2017, from http://www.cnn.com/2016/11/03/health/kids-suicide-deaths-increase
Teresa King,
PMHC Intern