Article Review and Summary: Fowler, J.C. (2012). Suicide risk assessment in clinical practice: Pragmatic guidelines for imperfect assessments.

The assessment, management and treatment of suicidal patients is one of the most stressful tasks for clinicians. It is also one of the most difficult things for a clinician to predict. The Suicide Assessment Five-step Evaluation and Triage (SAFE-T) is recommended as a practical multidimensional assessment protocol integrating the best-known risk and protective factors.

 

Suicide rates have risen approximately 60% over the last 45 years, with yearly estimates of one million suicides worldwide. More than 32,000 suicides occurred in the United States annually with suicide as the second leading cause of death among 25-34 year-olds and the third leading cause of death for people between 15-24 year-olds. Suicide attempts are 10 to 40 times greater than completed suicides, with U.S. estimates close to 650,000 per year.

 

Data has demonstrated that 28% of psychologists and 62% of psychiatrists have experienced the loss of a patient to suicide, most frequently in outpatient settings. The most important goal of suicide risk assessment should be conducted within a therapeutic frame in which collaboration and negotiation of role responsibilities are clearly expressed.

 

The clinical community does not yet possess a single test, or panel of tests that accurately identifies the emergence of a suicide crisis. One of the main reasons for this is that suicide risk is fluid, highly state-dependent, and variable over time. Research has shown that statistical associations among various risk factors gathered across large groups of individuals; however, translating elevated risk to the single individual falters because specific predictors are found among many individuals who are not suicidal (resulting in high false-positive prediction).

 

Among the hundreds of different interventions for suicidality, the following treatments appear particularly effective in randomized clinical control trials: lithium prophylaxis for mood disorders, clozapine for psychotic disorders, psychosocial treatments for suicidal patients with borderline personality disorder, and outreach through communicating care and concern, or in-home psychodynamic consultations. Developing and maintaining a caring interpersonal contact (even if by letter or phone) is important in reducing suicide risk. The quality of social relationships can either serve as a protective or risk factor. The quality of a collaborative therapeutic relationship, the clinician’s ongoing care and interest in the patient, and efforts to repair ruptures in the alliance may exert a powerful influence on the patient’s degree of hope for the future, and the degree to which suicidal-related behaviors decrease. Recent trials of a suicide prevention strategy that was based on collaboration, therapeutic alliance, and enhancing social contacts were found to reduce rates of suicidality. Due to these reasons, it is recommended that clinicians work to enhance the therapeutic alliance, consider recent ruptures that may contribute to suicidal ideation, and work to develop a collaborative approach to understanding the underlying causes for suicidal ideation.

You can do it.

 

Risk factors for suicide and suicide attempts include being younger than 25 years of age, female, less educated, unmarried, and having a mental disorder (mood disorders in high income countries, and impulsive disorders in middle and low income countries) each imparted a degree of risk for suicide-related behaviors, with risk increasing with greater psychiatric comorbidity. This information is useful in developing targeted programs for intervention and prevention.

 

Retrospective and psychological autopsy studies have indicated that a diagnosable mental illness is present in at least 90% of all completed suicides. Researchers have found increased suicide risk for all psychiatric disorders except for intellectual disability. Suicide mortality rates were highest for individuals diagnosed with substance abuse and eating disorders, moderately high rates for mood and personality disorders, and relatively low rates for anxiety disorders. Recent evidence from a 10-year prospective study of suicidal ideation, suicide plans and attempts revealed that the total number of co-occurring psychiatric disorders was consistently more predictive of subsequent suicide-related behaviors than types of disorders. A 3-year prospective study reveled that individuals with comorbid substance abuse disorders and borderline personality disorder were more likely to make future suicide attempts. Other researchers found that comorbid major depression and borderline personality disorder, in combination with poor social adjustment was predictive of suicide attempts at 12-month follow-up. Severity of personality pathology (meeting criteria for two or more personality disorders) was correlated with recurrent suicide attempts, but this effect held true only for younger females with severe personality disorders.

 

Currently the strongest risk factor for predicting suicide and suicide-related behavior is the history of suicide attempts. History of suicide attempt(s) is the greatest risk factor for future attempts, and death by suicide. Medically serious suicide attempts are strongly associated with the increased risk of mortality and repeated suicide attempts: a 5-year follow-up study found that individuals who made a single suicide attempt were 48 times more likely to die by suicide than the average person. Warning signs such as thoughts of suicide, preparatory acts, stressful life events, and cognitive/affective states are episodic, and therefore may be more predictive of an imminent suicidal crisis.

 

Most individuals contemplating suicide do so for extended periods without following through on the thoughts. Results from another study are chilling: a prospective study of 76 psychiatric inpatients found that 78% of individuals who completed suicide had denied suicidal ideation or intent during their last human contact before their death. Interview strategies focusing on current affective states while intentionally avoiding reference to suicide extract dimensions of cognition and affective functioning using the Rorschach Inkblot Method have shown considerable predictive validity with uncharacteristically low levels of false-positive prediction. Of considerable importance is the fact that two implicit measures demonstrated incremental validity over and above a history of past suicide attempts. Stressful life events, particularly those involving loss or threat to the stability of interpersonal relationships are associated with suicide risk. More recently, researchers examined the link between personality disorders and specific negative life events in the month preceding a suicide attempt and found that those who made suicide attempts were more likely to have experienced a negative stressful life event related to love and marriage problems, or legal troubles such as incarceration. Psychiatric hospitalization may function as a stressful life event, despite the intended purpose of decreasing suicide risk. Numerous studies demonstrate that risk of future suicide is greater shortly after admission and discharge. Suicide risk has found to spike immediately after admission and one-week post-discharge, and the risk of suicide is greatest for individuals with hospital stays less than the national median (estimated at 17 days). A second study found that the first day, first week, and first month post-discharge were the highest risk periods, and were strongly associated with patient-initiated discharge and failure to follow-up with post-discharge care, but not duration of hospitalization.

 

Most theories suggest an underlying genetic vulnerability that is triggered by early adverse events, resulting in impaired development and function of neurobiological systems regulating behavior, affect, and cognitive function. Impairments in stress response systems may then be overwhelmed (during adolescence and adulthood) in response to episodic negative life events, increasing the likelihood of triggering a suicidal crisis. Thus, underlying genetic and psychological vulnerabilities are assumed to be triggered by environmental stressors, increasing likelihood of negative outcomes including suicidal behavior. Studies generally support diathesis-stress models for predicting suicide-risk – interactions between early adverse events and current impulsivity, loneliness and recent stressful life events, and level of psychopathology and recent stressful life events in alcoholics confer increase risk of suicide-related behaviors. Multiple suicide attempts may lead to habituation by reducing normal barriers such as pain, fear of death, and negative social consequences. An intriguing gene-environmental study demonstrated a link between the serotonin transporter functional promoter polymorphism (5-HTTLPR), recent stressful life events, and suicide-related behavior. In this study, a combination of four or more stressful life events was associated with increased suicidal ideation and attempts for individuals with two copies of the short form of the 5-HTTLPR gene, but had minimal effect on those with long forms of the gene.

 

The ability to maintain a cognitive set regarding reasons for living appears to function as a protective factor. In a cross-sectional study, depressed patients who had not previously attempted suicide were found to have expressed more feelings of responsibility toward their children and families, feared social disapproval, had more moral objections to suicide, greater survival and coping skills, as well as greater fear of suicide than a matched cohort of depressed patients who had previously attempted suicide. In a two-year prospective study, reasons for living were a protective factor against future suicide attempts among depressed female inpatients, but not for their male counterparts. Health and well-developed coping skills may provide a buffer against stressful life events, decreasing the likelihood of suicidal behavior. Another protective factor includes moral objections and strength of religious convictions appears protective. In general, individuals are less likely to act on suicidal thoughts when they hold strong religious convictions and a belief that suicide is morally incompatible with belief. Religious and spiritual beliefs and techniques may decrease suicide risk by providing coping strategies and a sense of hope and purpose. Involvement in religious organizations may also increase resiliency by enhancing more stable supportive social networks. Marriage also imparts a degree of protecting against suicide, yet the presence of a high-conflict or violent marriage can function as a risk factor. Feeling safe at school was one of the most consistent protective factors against suicidal ideation and suicide attempts among teens. Strong family attachment when coupled with a cohesive neighborhood network also reduces the risk of adolescent suicide attempts.

 

When initiating treatment with high-risk patients, it is best to negotiate a collaborative treatment approach to suicidal thoughts and behaviors that includes: a clear plan for de-escalating a suicidal crisis, negotiation of the mutual and individual responsibilities of clinician and patient in establishing and maintaining the patient’s safety, and agreement to explore the precipitants and meaning of the crisis once it has past. Knowing that patients often deny suicidal thoughts before suicide attempt and death, clinicians should remain appropriately cautious regarding declarations of safety when a patient recently expressed suicidal ideation, feelings of hopeless, desperation, and/or affective flooding. This does not mean we adopt a suspicious or adversarial stance but a curious, concern, and calm acceptance of the patient’s emotional and cognitive states may serve to enhance the therapeutic alliance, encourage the patient to directly explore his or her current distress, and aid in the accurate evaluation of current functioning. Before conducting a formal suicide assessment, clinicians should conduct an introspective review of recent stressful life events facing the patient.

 

The Suicide Assessment Five-step Evaluation and Triage (SAFE-T) includes clinicians following these steps: (1) identifying relevant risk factors (noting those that are modifiable and therefore targeted for treatment), (2) identifying protective factors, (3) conducting a suicide inquiry including current suicidal thoughts, plans, behavior, and intent, (4) determining level of risk and select interventions to reduce risk, and (5) documenting the assessment of risk, the rationale for the chosen interventions, and follow-up after assessment and interventions. Focusing on the therapeutic relationship, and using the therapeutic alliance as a platform for exploring the causes and meaning of suicidal thoughts, clinician and patient may increase the likelihood of working together to avert suicide-related outcomes.

 

Fowler, J.C. (2012). Suicide risk assessment in clinical practice: Pragmatic guidelines for imperfect assessments. Psychotherapy 49 (1). 81-90.

 

Cindy A. Geil, M.A.
WKPIC Doctoral Intern

 

 

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Friday Factoids: Re-ignite Those New Year Resolutions!

 

 

The New Year arrived with great fanfare, and you began an exercise program, a diet regimen, a book reading class, or Dr. Vaught’s leadership course. Whatever choice you made, as time went by, your commitment waned. You may have said, “I just don’t have the time.”

 

We are all governed by time. How fast does time pass? I know I may  date myself, but I’m reminded of an old T.V. commercial when a man talks with an owl and says, “How many licks does it take to get to the center of a lollipop? Then the owl responds, “Let’s see… one… two… three,” and eats the lollipop. Then the commercial ends saying, “The world may never know.” The commercial reminds me of the concept of time; no one never knows where the time has gone. Ok, probably not a very good analogy, so let’s get back to the matter at hand.  Four to five weeks into the New Year, life again begins to beat you down. Work schedules increase, long afternoon meetings appear, the calendar fills, classes begin again, hours of study are required, and you tell yourself, “I do not have time.” Suddenly, a month passes, two months, perhaps three months have passed. No results! Now what?

 

Make the most of time. Be honest and set realistic goals. Sounds like familiar comments from others? In her news article entitled, “This Is Why You Can Never Keep Your New Year’s Resolutions,” Columnist Carolyn Gregoire writes about making decisions about how you will live your life. The answer may be hidden in a single word “habit.” Exercising good habits is a motivator in which one gains a sense of comfort and tough mindedness in self and one’s abilities. Gregoire (2014) quotes Charles Duhigg, a reporter and author of The Power of Habit, stating, “Routines and habits are a powerful force underlying much of our behavior.” After a brief review of the literature, Duhigg (as cited by Gregoire) found that nearly half or 50% of daily decisions are habit-driven. Not to oversimplify its significance, but if one develops a habit of doing anything, such as bathing, brushing teeth, or putting on deodorant, it no longer becomes a task, rather a lifestyle change and ultimately will no longer an issue of time.

 

Duhigg writes about five evidenced-based steps to re-ignite a not so old resolution. I will give you the first step: “Make it an action, not a goal.” Remember, these steps can apply to any situation, not just exercise. Take a look at the remaining steps here.

 

Reference: Gregoire, C. (2014).  This is why you can never keep your new year’s resolutions. The Huffington Post. Retrieved from http://www.huffingtonpost.com/2014/01/01/the-psychology-of-making-_n_4475502.html .

 

David J. Wright, MA., MSW
WKPIC Doctoral Intern

 

 

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Friday Factoids: A Look At “When Spring Brings You Down” by Linda Andrews

 

 

Spring time is in the air, woohoo! Finally! With the cold weather behind us and the polar vortex no longer a significant threat, it is time to peel off the long winter coat and open the window blinds in your office to let the sun in [given there are windows in your office]. With the spring comes many perks, such as viewing the beautiful landscape of the soft Kentucky bluegrass, the green leaves hanging on the oak trees, colorful flowers, and the fresh smell of daffodils.

 

Sounds fantastic, right!

 

Well, not so fast.

 

In her article, When Spring Brings You Down, Andrews (2012) writes about two issues that are not so welcoming with the change of season. She mentions “seasonal allergies and reverse seasonal affective disorder (SAD).”  Seasonal allergy sufferers are vulnerable to inflammation and infection. As a result, Andrews states that the molecule, cytokines, forms clusters around the infected area (Mandal, n.d.), which has been linked to depression and in severe cases, suicide. An additional reading source by David Dobbs, entitled, Clues in the Cycle of Suicide, provides more information about suicide rates during the spring and into the summer months.

 

Interestingly, Andrews further talks about SAD and the possibility that it is not specific to the winter months, but to the summer as well.  As the DSM-5 begins to take center stage, SAD will no longer be a separate diagnosis. Rather, SAD will take the form of several specifiers for major depressive disorder, recurrent and bipolar I and II disorders (DSM-5; pgs153-154; 187-188).

 

Yes, you may have already noticed that specifiers rule in DSM-5.

 

In the end, however, the spring air, filled with its freshness and good spirits, may not be a time of optimism for some individuals.

 

References:

 

American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5).

 

 

Andrews, L. (2012). When spring brings you down. Retrieved from
http://www.psychologytoday.com/blog/minding-the-body/201203/when-spring-brings-you-  down.

 

 

 

Dobbs, D. (2013).  Clues in the cycle of suicide. Retrieved from http://well.blogs.nytimes.com/2013/06/24/clues-in-the-cycle-of-suicide/?_php=true&_type=blogs&_r=0.

 

 

Mandal, A. (n.d.). What are cytokines? Retrieved from http://www.news-       medical.net/health/What-are-Cytokines.aspx.

 

 

 

David Wright, MA, MSW

WKPIC Doctoral Intern

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Article Summary of Risk Factors for Violence in Psychosis: Systematic Review and Meta-Regression Analysis of 110 Studies

 

 

Witt, van Dorn, and Fazel (2013) noted many inconsistencies and varying emphases in the current literature on the association of violence and psychosis. This led the researchers to perform a meta-analyses of the current literature base, essentially combining all current studies on violence risk and psychosis into one helpful summary. The authors noted this task is important to the field for several reasons. First, combining and analyzing this information would hopefully help to develop evidence-based approaches to risk assessment. Next, this information can help focus treatment with relevant populations to the most pertinent risk factors, while simultaneously enhancing protective factors. Finally, consolidating this information can help clinicians and researchers better understand why certain individuals with psychosis have a higher risk of violence.

 

Six major databases were searched from their inception until December 2011. For some databases, this meant going back as far as 1960. Non-English articles were translated by qualified post-graduate students. For inclusion, diagnoses had to be assigned based on Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) criteria, and more than 95% of study participants were aged 18 or older and diagnosed with either schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, schizotypal disorder, psychosis not otherwise specified, and bipolar disorder. It is important to note that psychoses as the result of medical conditions, substance intoxication, or substance withdrawal were excluded from the collected data. Studies were excluded if the focus was on genetic or epigenetic associations with violence, childhood violence, or offender populations. Furthermore, items were only included in the data collection process if the risk factor was included in three or more separate studies, which helped improve the validity of risk estimates. Risk factors were separated by time in that “recent” factors were those that occurred within the past year from the time of the original study, while “history of” factors were those that occurred at some point in the past, more than one year from the time of the original study. Data collected from each study may have been reported in different measurements; therefore, all collected data was converted to an odds ratio (ORs). For each factor identified, ORs, 95% confidence intervals, number of studies, the z score, number of violent participants, and total number of participants were reported.

 

A total of 110 studies that included 73 independent samples met inclusion criteria. This equated to a large number of participants (n=45,533) of whom 18.5% (8,439) were reported to be violent. Just over 85% of participants were diagnosed with schizophrenia, just under 12% were diagnosed with other psychoses, and 0.4% were diagnosed with bipolar disorder. The age of participants ranged from 21.1 to 54.3 years, with the average age of 35.8 years. The data included studies conducted in 27 countries.

 

Overall, the strongest domains associated with violence include the criminal history, substance misuse, demographic, and premorbid factors. When analysis was restricted to inpatient samples, the substance misuse domain was significantly associated with violence, but less so compared to the findings in the overall analysis. Additionally, analysis restricted to inpatient samples found the psychopathology and positive symptom domains were more strongly associated with violence, while the negative symptom, neuropsychological, demographic, premorbid, suicidality, and treatment-related domains were not significantly associated with risk of violence when compared to the overall analysis. The finding of differences in factors associated with violence among inpatient samples versus community samples could lend itself to the field developing different violence risk assessment approaches depending on whether the individual is in inpatient or outpatient treatment currently. A rather interesting finding was the association of previous suicide attempts with violence, especially considering most current and commonly used violence risk assessments do not usually include assessment of suicide. The authors speculate that history of previous suicide attempts was associated with violence, while experiencing suicidal ideation was not, because impulsivity may be a contributing factor to violence toward self and violence toward others. The authors close by identifying the most important factors to attend to during violence risk assessments: hostile behavior, poor impulse control, lack of insight, general symptom scores, recent alcohol and/or drug misuse, psychotherapy non-compliance, and medication non-compliance.

 

The major findings are described below in outline format for easy reference.

  • Demographic Factors
    • Strongly associated with violence:
      • History of being violently victimized
    • Moderately associated with violence:
      • Recent homelessness or history of homelessness
      • Male
    • Weakly associated with violence:
      • Member of ethnic minorities
      • Currently having a lower socioeconomic status
    • NOT significantly associated with violence:
      • Received no more than a primary school education
      • Received no more than a high school education
      • Lower family socioeconomic status during childhood
      • Shorter duration of education in years
      • Lacking any formal education qualifications
      • Currently living in an urban environment
      • Currently living alone
      • Unmarried
      • Widowed or divorced
      • Currently unemployed
      • Having children
      • Younger age at study enrollment in years
  • Premorbid Factors
    • Moderately associated with violence:
      • History of childhood physical or sexual abuse
      • Parental history of criminal involvement
      • Parental history of alcohol misuse
    • NOT significantly associated with violence:
      • Experienced the death of one parent during childhood
      • Experienced divorce or separation of parents during childhood
      • Raised by a single parent
  • Criminal History Factors
    • Significantly associated with violence:
      • History of assault
      • History of imprisonment for any offense
      • Recent arrest or history of arrest for any offense
      • History of conviction for a violent offense
      • History of violent behavior
      • Hostility during the study period
  • Psychopathological Factors
    • Strongly associated with violence:
      • Lack of insight
      • Poor impulse control
    • Moderately associated with violence:
      • Diagnosis of comorbid antisocial personality disorder
      • Higher total Positive and Negative Symptom Scale (PANSS) scores
    • NOT significantly associated with violence:
      • Diagnosed with bipolar disorder
      • Diagnosed with any subtype of schizophrenia
      • Diagnosed with schizoaffective disorder
      • Diagnosed with psychotic disorder not otherwise specified
      • Younger age of onset in years
  • Positive Symptom Factors
    • Associated with violence:
      • Higher positive symptom scores
    • NOT significantly associated with violence:
      • Experienced paranoid thoughts
      • Experienced delusions of any type
      • Experienced auditory hallucinations, including command auditory hallucinations
      • Acutely symptomatic
  • Negative Symptom Factors
    • NOT significantly associated with violence:
      • Higher poor attention span scores
      • Diagnosed with comorbid depression
  • Neuropsychological Factors
    • NOT significantly associated with violence:
      • Lower Full Scale IQ scores on the Wechsler Adult Intelligence Scale (WAIS)
      • Lower Performance IQ scores on the WAIS
      • Lower Verbal IQ scores on the WAIS
      • Lower scores on the Picture Completion subtest of the WAIS
      • Lower total scores on the National Adult Reading Test (NART)
      • Higher perseverative errors on the Wisconsin Card Sorting Test
  • Substance Misuse Factors
    • Strongly associated with violence:
      • History of polysubstance misuse
      • Diagnosis of comorbid substance use disorder
      • Recent substance misuse
    • Moderately associated with violence:
      • Recent or history of alcohol misuse
      • History of substance misuse
      • Recent or history of drug misuse
  • Treatment-Related Factors
    • Strongly associated with violence:
      • Psychotherapy treatment non-compliance
    • Moderately associated with violence:
      • Medication non-compliance
    • NOT significantly associated with violence:
      • Not having a prescription of antipsychotic medication of any type
      • Higher antipsychotic dosage
      • Shorter duration of antipsychotic treatment in months
      • Shorter duration of current inpatient admission in months
      • Shorter duration of current outpatient treatment in months
      • Younger age at first psychiatric inpatient admission in years
      • Greater number of previous psychiatric admissions
      • Longer duration of untreated illness in years
  • Suicide Factors
    • Moderately associated with violence:
      • History of previous suicide attempts
    • NOT significantly associated with violence:
      • History of experiencing suicidal ideation
      • History of self-harm

Witt, K., van Dorn, R., & Fazel, S. (2013). Risk factors for violence in psychosis: Systematic review and meta-regression analysis of 110 studies. PLOS One, 8(2), 1-15.

 

Danielle M. McNeill, M.S., M.A.
Doctoral Intern

 

 

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Friday Factoids: Synthetic Marijuana: Frequently Asked Questions

 

 

What is synthetic marijuana?

  • A man-made substance that is allegedly supposed to mimic the effects of tetrahydrocannabinol (THC), which is a cannabanoid and the primary psychoactive ingredient in cannabis.
  • The substance is manufactured and then coated on to dried herbs, which are ingested by smoking the substance.
  • It is now the 2nd most commonly abused illicit drug among high school seniors, behind traditional marijuana, according to the National Institute on Drug Abuse (NIDA).
  • Synthetic cannabinoids are significantly more potent than THC, with different effects, and different chemical structures.
  • It can be found in stores labeled as “incense” or “herbal incense,” and often has the label “not for human consumption.”

 

When I hear the term “synthetic drug,” does this mean synthetic marijuana?

  • There are two main forms of synthetic substances—synthetic cannabinoid and synthetic cathinone. Synthetic cannaboinoid is commonly called synthetic marijuana, while synthetic cathinone is more similar to cocaine and often called “bath salts.”

 

What are some common names for synthetic marijuana?

  • Spice, K2, Mr. Nice Guy, Mr. Smiley, Blaze, Black Mamba, Sexy Monkey, Genie, and others

 

You can buy this in the store, is it legal?

  • Yes and no. The Drug Enforcement Agency (DEA) has classified several synthetic chemicals (JWH-018; JWH-073; JWH-200; CP-47,497; cannabicyclohexanol) as a Schedule I substance. Since banned by the DEA, the United States Food and Drug Administration (FDA) will not approve the substance for human consumption.
  • As of March 2011, 20 states have imposed bans on these substances, with additional legislation pending in 37 states.
  • Being a Schedule I substance places these strands of synthetic marijuana in the same category as LSD and heroin. Schedule I drugs have a high potential for abuse, lacks accepted safety standards for use under medical supervision, and provides no currently accepted medical use.
  • Bans on this substance are not only found in the United States, but also in Britain, Germany, Poland, France, and Canada.
  • However, there are challenges in making the substances illegal because there are literally hundreds of formulations. Manufacturers of the substances are changing the ingredients quicker than states and the DEA can classify them as illegal.

 

How is synthetic marijuana similar to regular marijuana?

  • These substances are similar in appearance, consumption method of smoking, and feeling of euphoria after inhalation.

 

What makes this an attractive substance for users?

  • It is readily available in stores and online, and generally low cost. Additionally, synthetic marijuana does not typically show up on traditional urine drug screens.

 

What are the dangers of synthetic marijuana?

  • Research has found that the chemicals in synthetic marijuana are significantly more potent than the THC found in marijuana. Synthetic cannabinoids are full agnoists, meaning they bind to cannabinoid receptors and fully stimulate the receptors. THC, the main psychoactive ingredient in traditional marijuana is a partial agonist, which means THC only partially stimulates cannabinoid receptors.
  • Since synthetic marijuana is a man-made substance, potency can vary per package and per strand. This increases the potential for overdose.
  • Similarly, given the fact synthetic marijuana is a man-made substance, human error and how one batch is mixed is a factor in potency.
  • Also, there are quite a few significant negative effects or side effects.

 

What are the negative effects?

  • Seizures and convulsions, difficulty breathing, racing heart beat, elevated blood pressure, nausea, vomiting, loss of consciousness, stroke, paranoia, muscle twitching, agitation, anxiety, sweating, hallucinations, harmful effects on the cardiovascular and central nervous systems, lack of pain response, and lack of judgment.
  • The experience of paranoia, agitation, and hallucinations is common, even for those with no prior history of mental illness.
  • The impact on judgment and pain response has been associated with increased unpredictable, and dangerous behaviors, such as running into traffic.
  • It is common for users to require medical treatment and intensive care. It is also common for users to be involuntarily committed to psychiatric hospitals, especially when the cause of his or her erratic behavior is unknown.
  • Visits to the emergency room due to use of the substance has increased from 13 in 2009 to approximately 560 by early 2010. By December 2010, approximately 2500 calls related to synthetic marijuana use were made to poison control centers. Even more troubling, calls related to synthetic drugs quadrupled from 2010 to 2011, according to the American Association of Poison Control Centers (AAPCC). Approximately 60% of cases involve individuals aged 25 and younger.
  • Use of synthetic marijuana can result in organ failure, kidney failure, respiratory failure, and death. Fatalities are often related to cardiac events, seizures, and hyperthermia.

 

How long can negative effects last?

  • While research is minimal, some studies do indicate there is a concern for possible short- and long-term effects after use.

 

Is it addictive?

  • Research in Germany indicated that the use of synthetic marijuana can lead to symptoms of withdrawal and “addictive behaviors.”

 

Has synthetic marijuana really caused such negative effects in people?

  • There have been reports in the new about male and female adolescents and adults experiencing significant complications after using synthetic marijuana. These instances have occurred in several states and are not limited to geographic region. There have been reports of a teenage female having a series of strokes that left her blind and paralyzed after using the substance. Another report of a teenage male experiencing seizures after use, while another male teen allegedly committed suicide after use, can be found in the news. The reports are not just limited to teenagers. An adult man presented for emergency medical services after an overdose characterized by severe agitation and heart rate around 200 beats per minute (more than twice the normal speed).

 

References


Macher, R., Burke, T. W., & Owen, S. S. (2012). Synthetic marijuana. FBI Law Enforcement Bulletin, 81(5), 17-22.

Van Pelt, J. (2012). Synthetic drugs—Fake substances, real dangers. Social Work Today, 12(4), 12.

 

Danielle M. McNeill, M.S., M.A.
WKPIC Doctoral Intern

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Friday Factoids: Open Your DSM-5!

 

 

If you have been avoidant of opening your new DSM-5 and reviewing the changes, there is one reason to go ahead to check it out. The DSM-5 includes screening questionnaires in Section III of the book, which are also found on the DSM-5 website (http://www.psychiatry.org/practice/dsm/dsm5/online-assessment-measures) with additional measures not found in the book.

 

The assessments include adult, child, collateral informant, and clinician ratings, depending on the measure. There are general measures, disorder/area specific measures, severity measures, personality measures, measures for level of disability impairment, and cultural measures. These measures can be used to aid in diagnostic clarification, as well as to track changes across therapy sessions. The best part is they are free to use and conveniently available online.

 

Have a client receiving treatment for panic disorder? There is a symptom specific measure that can be given each session and compared to previous administrations to track changes, as well as provide a tangible example for the client showing his or her progress over time. Don’t forget to check out the DSM-5 website (www.dsm5.org) for updates to the manual. There is already a handful of updates available with changes to codes and errors in wording.

 

 

Danielle McNeill, M.S., M.A.
WKPIC Doctoral Intern

 

 

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Friday Factoids: Being Patient With Yourself As A New Therapist

 

 

If you feel like you don’t know what you’re doing, you’re doing it right!

 
Beginning therapists often struggle with feelings of inadequacy and ineffectiveness when first meeting with clients. Teyber and McClure (2011) offer validation and guidance for these common, and often unacknowledged, experiences for students. The authors state, “…new therapists need to be patient with themselves and appreciate that learning to be an effective therapist is a long-term developmental process” (Teyber & McClure, 2011, p. 4).

 

The authors explain the path to feeling more grounded and confident in therapy can take three to five years. It is important for beginning therapists to realize their feelings are normal. It is also important that new therapists refrain from putting pressure on themselves when they perceive this process is taking too long.

 

Teyber, E., & McClure, F. H. (2011). Interpersonal process in therapy: An integrative model (6th ed.). Belmont, CA: Brooks/Cole.

 

Danielle M. McNeill, M.S., M.A.
WKPIC Psychology Intern

 

 

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Friday Factoids: Anger Rules and the Anger Thermometer

 

One of the most common problems in children with behavioral issues is the anger they experience. Behaviorally disordered children may get angry much easier and quicker than their peers. Therapists working with children are in need of interventions that can help a child to think before he acts.

 

One of the interventions Dr. Tony Sheppard (2012) recommends is the concept of the Anger Rules. The Anger Rules involves a child making a decision regarding his anger or looking at how he handled his anger after the fact. The Anger Rules offer a very simple set of guidelines for checking ourselves when faced with a difficult situation. This concept is discussed in the anger workbook, A Volcano in My Tummy, by Elaine Whitehouse and Warwick Pudney. This workbook teaches there are two general categories of responses to anger: clean and dirty. Clean anger is the type that obeys all of the Anger Rules while dirty anger violates one or more of the Anger Rules. This concept offers a very simple way for the child to check himself with how he has managed his anger. An example involves a lunch line situation in which a child throws a lunch tray at the wall. By using the Anger Rules checklist, the child asks, “Did I hurt others? No. Did I hurt myself? No. Did I hurt property? Yes.” Therefore, throwing a tray at the wall was, in fact, dirty anger.

 

Now if the child thinks before he acts, his anger is rising to the top of the Anger Thermometer because the child behind him is standing too close and bumping into him. The child thinks to himself, “I need to get the teacher or I am going to hit this kid!” The Anger Rules asks: “Will this hurt others? No. Will it hurt me? No. Will it hurt property? No.” Getting the teacher for help before acting is an example of clean anger. Processing situations and looking at clean versus dirty anger can really help a child to think before he acts and figure out the best course of action for that particular situation.

 

Sheppard, T.L. (2012). Parent guide to the anger thermometer and the anger rules. Groupworks Inc.

 

Cindy A. Geil, M.A.
WKPIC Doctoral Intern

 

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Welcome to the 2014-2015 Internship Class

Hooray!

 

 

WKPIC is thrilled to announce that we filled our 3 slots during Round I of Match this year–with awesome students! We extend a hearty welcome to Brittany Best, Faisal Roberts, and Graham Martin. We look forward to working with all of you come September!

 

 

 

Susan R. Vaught, Ph.D.
WKPIC Training Director

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Friday Factoids: It IS Possible to Work With Teen Girls

 

Many therapists see the same types of issues when working with teenage girls – girls struggle with their self-identity, low self-esteem, body issues, trying to fit in and ensure people will like and accept them.

 

Pipher (1994) in her book, Reviving Ophelia: Saving the Selves of Adolescent Girls, discusses these issues that adolescent girls deal with in their everyday lives. Pipher (1994) discusses a scene in which she was sitting on a bench outside of her favorite ice-cream store. She saw a mother and teenage daughter stop in front of her and wait for the light to change. She heard the mother say, “You have got to stop blackmailing your father and me. Every time you don’t get what you want, you tell us that you want to run away from home or kill yourself. What’s happened to you? You use to be able to handle not getting your way.” The daughter stared blankly straight ahead, barely acknowledging her mother’s words. The light changed and next she saw a very different scene. Another mother approached the same light with her preadolescent daughter. The mother and daughter were holding hands. The daughter said to the mother, “This is fun. Let’s do this all afternoon.”

 

Something very dramatic takes place to girls in early adolescence. Just as planes and ships disappear mysteriously into the Bermuda Triangle, so do the selves of girls. They crash and burn in a social and developmental Bermuda Triangle taking the happiness away from them. In early adolescence, studies show that girls’ IQ scores drop. Girls lose their assertive, energetic personalities and become more deferential, self-critical, and depressed. They report great unhappiness with their bodies. Girls are often happy and free but then loose themselves in adolescence. They often fall in love with boys and live only for their approval. Girls have no sense of inner direction; rather they struggle to meet the demands of others. Their value is determined only by their approval. A girl once said, “Everything good in me died in junior high.”

 

Pipher then discusses some interventions she uses with these adolescent girls. The most important question she says she asks her adolescent clients is “Who are you?” She says she is not as interested in the answer as in teaching a process that the girl can use for the rest of her life. The process involves looking within to find a true core of self, acknowledging unique gifts, accepting all feelings, not just socially acceptable ones, and making deep and firm decisions about values and meaning. It includes discussion about breaking the cultural rules set out for women and formulating new, healthy guidelines for the self. These girls must figure out ways to be independent from their parents and stay emotionally connected to them. They need to discover ways to achieve and still be loved. They must discover moral and meaningful ways to express their sexuality in a culture that blasts them with plastic, pathetic models of sexuality. They have to learn to respect themselves in a culture in which attractiveness is women’s most defining characteristic. Therefore, it is imperative that girls find, define, and maintain their true selves.

 

Pipher, M. (1994). Reviving ophelia: Saving the selves of adolescent girls. New York: Ballantine Books.

 

Cindy A. Geil, M.A.
WKPIC Doctoral Intern

 

 

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