Friday Factoids: A Call for Action on Teen Violence

 

 

Amid the rise in teen violence, one must agree that our society’s most precious resource is endangered. Violence among teens seems to be a common theme in headline news.  On June 11, 2014, a news report on the Today Show indicated that there were 74 school killings since the Sandy Hook Shootings. Enough is enough!  I’m frustrated, angered, and enraged. What has occurred in our society that has led our teens astray and caused them to become violent individuals?

 

As future professional psychologists, how are we addressing this problem?  I encourage your feedback, thoughts, and answers. Below are just a few  news captions that are disturbing and should be a wakeup call for change to take place in our current system: “Brutal killing of teenage girl tied to suspects’ satanic ritual” (Rogers, 2014); “Colorado teen says he and his girlfriend killed grandparents for inheritance” (Associated Press, June, 2014); “Teen admits killing parents because they confiscated his iPod”  (Best, 2014); “Twisted Twins: Teens confess to brutal murder of mother” (Beck, 2014); “Ottawa teen killed at prom after-party in alcohol-fueled brawl” (Hensley, 2014).

 

These headlines of killings were brutal and senseless. Who is at fault? Nowadays, the media seems to fault parents. But, is this a fair statement?  Have parents given up on their children? Are parents afraid to chastise their kids in this day and age due to fear of imprisonment? Does government dictate how parents are to raise the kids of today?  Our most precious resource is hurting and need a voice. Are we to take the attitude of “the new normal”–or will we rise to this challenge and find new and different ways to combat this problem?

 

References
Associated Press (June, 2014). Colorado teen says he and his girlfriend killed grandparents for inheritance. Retrieved from http://www.foxnews.com/us/2014/06/05/colorado-teen-says-and-his-girlfriend-killed-grandparents-for-inheritance.

 

Beck, C. (2014). Twisted twins: Teens confess to brutal murder of mother. Retrieved from  http://www.11alive.com/story/news/local/conyers/2014/05/14/jasmiyah-tasmiyah-whitehead-murder-case-part-3/9107451.

 

Best, J. (2014). Teen admits killing parents because they confiscated his iPod. Retrieved from http://www.mirror.co.uk/news/world-news/teen-admits-killing-parents-because-3624833.

 

Hensley, N. (2014). Ottawa teen killed at prom after-party in alcohol-fueled brawl. Retrieved from http://www.nydailynews.com/news/crime/ottawa-teen-killed-prom-after-party-brawl-article-1.1821881.

 

Rogers, B. (2014). Brutal killing of teenage girl tied to suspects’ satanic ritual. Retrieved from  http://www.chron.com/neighborhood/bayarea/crime-courts/article/Brutal-killing-of-teenage-girl-tied-to-suspects-5226366.php.

 

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

 

 

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Friday Factoids: Link Between Vitamin D and and Psychosis?

 

One may have thought that vitamin D was only associated with bone density, skin conditions, sunlight exposure, or cardiovascular functioning. While it is commonly known throughout the medical and psychological community that vitamin D is linked to brain development and functioning, recent studies suggest that a deficiency in vitamin D may correlate to brain dysfunction and the onset of psychosis, including major depression and schizophrenia.

 

As cited by Brauser (2013), researchers conducting a study in the United Kingdom determined that patients at an in-patient psychiatric facility who presented with first-episodes of psychosis (FEC) had very low levels of vitamin D, and surprisingly were three times more likely to be completely deficient in vitamin D than their healthy same-aged peers. Vitamin D is unlike many other vitamins. It is also a steroid hormone that releases neurotransmitters such as serotonin and dopamine.  According to Greenblatt (2011), researchers found vitamin D receptors on cells in the region of the brain associated with depression. Greenblatt further stated that numerous research studies determined that low levels of vitamin D3 have been linked to Seasonal Affective Disorder; affecting serotonin levels in the brain.

 

While research studies do show a link between vitamin D deficiency and depression, it is unclear whether the relationship is causal. Brauser quoted Dr. John Lally, a clinical research fellow at United Kingdom National Psychosis Unit, stating: “we are not sure whether vitamin D deficiency is part of the psychosis itself or the result of lifestyle choices.”  Dr. Lally further said that extended periods of hospitalization and the use of anticonvulsants may also cause a deficiency in vitamin D. Interestingly, further examination is needed to determine the causal relationship between vitamin D and the early onset of psychosis. Perhaps the takeaway for clinicians is to consider vitamin D levels in their patients and its impact on their mental health.

 

References:

Brauser, D. (2013).  Vitamin D deficiency linked to onset of psychosis. Retrieved from http://www.medscape.com/viewarticle/813637

 

Greenblatt, J. M. (2011).  Psychological consequences of Vitamin D deficiency.  Retrieved from http://www.psychologytoday.com/blog/the-breakthrough-depression-solution/201111/psychological-consequences-vitamin-d-deficiency

 

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

 

 

 

 

 

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Friday Factoids: Bullying and Risk for Suicide

 

 

One of the most common concerns that arise in counseling with children and teens is the aspect of bullying. Bullying can have lasting effects on a person’s self-esteem and view of himself.

 

Dr. Susan Swearer, bullying expert, discussed in an article on the APA website (2010) how bullying is not a new issue. She discussed how a researcher in the early 1980s began studying bullying as a result of three boys ages 10 to 14 that committed suicide in 1982 due to being bullied. Dr. Swearer stated that where in the past bullying could only occur during face-to-face encounters, now with the widespread use of technology, bullying can occur seven days a week, 24 hours a day.

 

Dr. Swearer (2010) discussed that parents and teachers must intervene when they see bullying take place. The student(s) who are doing the bullying must be told to stop. The bullying behaviors need to be documented and be kept as records. One of the most important steps to take is for the victim to feel that they have a support network of students and adults. The student who is being bullied should feel connected to school and home. Students who are being bullied may also benefit from either individual or group therapy in a place where they are able to express their feelings.

 

Researchers have attempted to look at a student’s risk factor for committing suicide as a result of bullying. Every story has been found to be different but the one thing that is known is that depression is a risk factor for committing suicide; therefore, symptoms of depression in students should be taken very seriously and properly treated. Dr. Swearer discussed the importance of parents monitoring their child’s behavior online in order to ensure their child is not bullying others or a victim of bullying. Bullying is a real problem for children and teens and any psychologist who works with young people, who are being bullied, should assess and treat any signs of depression or anxiety and provide the proper support that the young person needs. (Swearer, 2010)

 

Swearer, S. (2010, April 2). Bullying: What parents, teachers can do to stop it. Retrieved from http://www.apa.org/news/press/releases/2010/04/bullying.aspx

 

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

 

 

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Friday Factoids: What is Play Therapy and Why Does It Matter?

 

 

Play is a child’s job when they are young. The natural medium of communication for children is play and activity. Play is the way children learn what no one can teach them.

Children’s play represents the attempt of children to organize their experiences and may be one of the few times in children’s lives when they feel more in control and therefore, more secure.

 

The philosophy behind child-centered play therapy considers play as essential to children’s healthy development and that play gives concrete form and expression to children’s inner worlds. Emotionally significant experiences are given meaningful expression through play. One of the major functions of play is changing of what may be unmanageable in reality to manageable situations through symbolic representation, which provides children with opportunities for learning to cope by engaging in self-directed exploration.

 

When a child is given complete freedom in her play, she can act out aspects of her life that are emotionally significant to her. A child can show through the use of toys how the child feels about herself and the significant persons in her life. When a therapist gets on the child’s comfort level through play, the play provides a means through which conflicts can be resolved and feelings can be communicated. Due to these reasons, play therapy is one of the most beneficial interventions with children with emotional and behavioral issues. (Landreth, 2002).

 

Landreth, G. L. (2002). Play therapy: The art of the relationship, 2nd ed. New-York, NY: Brunner-Routledge.

 

 

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

 

 

 

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Congratulations, Dr. Lorence!

 

Go big, or go home!

 

 

WKPIC would like to congratulate Margarita Lorence, 2012-2013 intern, on completing her dissertation and graduation requirements. Way to go, Dr. Lorence! Now, go change the world. We know you can do it.

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Friday Factoids: Therapist–Or Hypocrite?

 

 

askstephanNo one wants to be called a hypocrite. A hypocrite means you are a fraud. You say one thing but live in a different way. How many times are we hypocrites as therapists?

 

We tell our clients that they need to spend more quality time with their spouse or children but we stay at the office late into the evening and are too tired and worn out to spend quality time with our families once we get home. How many times have you recommended an exercise regimen to a client while you hit the snooze on the alarm skipping your workout time?

 

We, as therapists, often disregard our own advice by ignoring the messages we say day in and day out and fail to implement them in our own lives (Kottler, 2003). If we believe the advice is so important for a healthy life, why do we not take our own advice? When we fail to take care of ourselves and our personal lives it can lead to burnout and the inability to be good therapists to our clients. One of the most important things for our clients might be for us to leave the office and spend time with our family, replenishing ourselves so we are better equipped to work with them the next time we see them.

 

In summary, take your own advice!

 

Kottler, J. A. (2003). On being a therapist. 3rd ed. San Francisco, CA: Jossey-Bass.

 

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

 

 

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Friday Factoids: Trust and Caring are Keys to Clinical Supervision

 

 

As psychologists, we will most likely supervise practicum students, interns, or postdoctoral students at some point in our careers. Campbell (2006) explains that the key to a successful supervisory relationship is to create an atmosphere of safety and trust, promote shared understanding and agreement about the tasks and goals required, and be fair, respectful, and empathic toward the needs of supervisee.

 

One of the most important things a supervisor can do is to show the supervisee that you care about them on a personal level. The supervisee also needs to know that the supervisor genuinely cares about them on a professional level and is invested in their development as a psychologist. If a supervisee feels that the supervisor views them as a burden or another task to check off on their list of “to do’s,” a trusting relationship will never be developed. If a trusting relationship is never developed, the supervisee and his or her clients both suffer. A supervisee in this type of relationship will not feel that they can go to their supervisor for consultation without feeling that they are going to be brushed off quickly. Thus, the supervisee will stop going to the supervisor for advice.

 

Some personal attributes that have been identified as essential to effective supervision include trustworthiness, authenticity, genuineness, openness, tolerance, respect, empathy, flexibility, an ability to confront, a concern for supervisee’s growth and well-being, and sense of humor (Campbell, 2006). Often times, a supervisor will be the driving force that provides confidence to a training psychologist. What an amazing and influential responsibility! We might not always know the best answers as future supervisors but this can be easily forgiven when a supervisee and supervisor have a supportive and trusting relationship with each other.

 

Campbell, J. M. (2006). Essentials of clinical supervision. Hoboken, NJ: John Wiley & Sons, Inc.

 

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

 

 

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Article Review: Do Patients Improve After Short Psychiatric Admission? A Cohort Study in Italy

Does short inpatient care make a significant difference? Mental Health care professionals and treatment team staff here at Western State Hospital (WSH) ponder this question daily. Patients at WSH are admitted every day due to major psychopathology yet are discharged at increasing rates within 72 hours of admission. Recidivism rates worldwide are staggering and should be examined. Therefore, the undersigned decided to explore overseas into Italy’s mental health system seeking answers to the above mentioned question.

 

Over the past decade and beyond in the United States, acute psychiatric admissions have declined. In their article, “Do patients improve after short psychiatric admission? A cohort study in Italy,” Barbato, Parabiaghi, Panicali, Battino, D’Avanzo, De Girolamo, Rucci, & Santone, (2011) mentioned that approximately three weeks of hospitalization was defined as a “brief” admission. The authors further examined additional sources and found that a two week admission was considered an extended admission. Here one can already get a sense of the problem and the decrease in length of acute admissions. Not surprisingly, Barbato, et al mentioned that this decline was not only problematic in the United States of America, but overseas as well including Canada (seventeen days); England (eighteen days); Australia (eleven days); and Italy (twelve days). Given this scenario, one may estimate, with confidence, that brief admissions (i.e., acute levels or otherwise), especially patients presenting severe symptomatology, can face increased suicidal ideation or unnecessary readmission. Of course there are additional reasons to consider as causal factors for patient recidivism, such as medication non-adherence, lack of follow-up to aftercare therapy, and unstable social environment, just to name a few.  However, in this article, the author’s intent was to estimate the level of percentage change in symptoms at discharge. In others words, the authors assessed patients (n=206) utilizing the standardized Italian version of the Brief Psychiatric Rating Scale (BPRS) pre/post admission and again when transferred on an acute unit (pre/post) prior to discharge. The BPRS item scores ranged from one to seven and the total score ranged from 24 to 168 (Barbato, et al, 2011, p. 252). The BPRS factors positive symptoms of mania/disorganization, depression/anxiety and negative symptoms as well. The authors felt that the BPRS would identify patient outcome and could be used to guide effective treatment.

 

In comparison to the United States, inpatient care in Italy is distributed among public and private interests. In 2003, there were over 300 public facilities and over 50 private facilities responsible for the mental health needs of patients.  The authors gathered information on acute inpatient care by conducting surveys over two-phases that was accepted by the local Ethical Appraisal Panel of the National Health Institute. The research was sponsored by the Ministry of Health over a four year period in all regions except Sicily. Phase I explored the number of patients versus the average length of hospitalization plus resources, such as bed availability. Phase II involved indentifying a representative random sample of patients from both public and private facilities.

 

Statistical analysis:
The Mann–Whitney test was utilized for continuous variables and the X² test for categorical variables to compare between independent groups. The significance level of .05 was used and tests were two-tailed. The effect size was calculated by Cohen’s d, as the difference between the mean BPRS score at admission and discharge divided by the pooled standard deviation.

 

Results:
Out of 206 patients, clinical improvements were found in about one in seven patients after a brief admission.  Improvements were noted in the total and factor scores of the BPRS, with moderate to large effect sizes.  Statistical measures were conducted to record and track psychopathology at the group and individual levels. BPRS scores were captured at admission: Leucht et al. (2006) reviewed the clinical implications of BPRS scores and revealed that patients were indentified on average as moderately ill at admission with a mean score of 2.22, and as “mildly ill” at discharge (on the admissions unit), with a mean score of 1.73, which represented a 22% drop in BPRS score thus considered minimal improvement in approximately a one week period. Once discharged from admissions to an acute unit, the BPRS was again assessed.  Varner et al. (2000) assessed the outcomes of acute inpatient care that utilized an 18-item BPRS.  Varner et al. found that patients admitted to an acute unit scored 2.0 at baseline and 1.8, 1.5 and 1.4 on days 2, 7 and 14, respectively. The authors concluded that a minimum of seven days of hospitalization were needed to show improvement, which was based on patients that already showed marked improvement since day two.

 

Limitations:
1. The authors mentioned that diagnoses at admittance were not based on a comprehensive clinical interview, but rather based on observation and the BPRS was felt to be more effective and accurate. While the undersign believe that clinical observation cannot be discounted during the assessment process (one can collect valuable information through collateral resources, such as nursing staff, social workers, and psychiatrists), conducting a clinical interview, in my opinion, yields greater information than observation alone and an assessment tool.

 

2.  There was not a consistent sample of patients drawn for one facility, but from approximately three different facilities that increased the generalizability in treatment strategies that could not be accurately captured in statistical formulation.

 

Outcome assessment of short psychiatric hospitalization:
A study by Svindseth, et al. (2010) of acute inpatients revealed similar BPRS scores at admission (53.8 vs. 53.2), but noted that patient length of stay was longer (13 days vs. 5 – 7).  BPRS scores were helpful during the admissions process to identify mild to moderately ill patients. A great number of patients were identified as mildly impaired and therefore did not require acute hospitalization. The authors identified mildly impaired patients as those having mild levels of depression/anxiety, impairment in work and/or social functioning, social withdrawal, or family conflict. Those individuals were immediately discharged and recommended for outpatient clinical services.

 

In conclusion, there is a global urgency that exists for the continuity of care for mental health patients. Outpatient treatment is a critical and necessary component of the mental health community. While the authors have pointed to decreases in percentage and symptomatology on the inpatient admissions unit, time-limited acute care, although producing symptom improvement, is still considered too short to yield significant improvement.

 

References
Barbato, A., Parabiaghi, A., Panicali, F., Battino, N., D’Avanzo, B., De Girolamo, G., Rucci, P., & Santone, G. (2011). Do patients improve after short psychiatric admission? A cohort  study in Italy [on behalf of the PROGRESS-Acute Group]. Nordic Journal of Psychiatry, 65:251–258.

 

Leucht, S., Kane, J.M., Etschel, E., Kissling,W., Hamann, J., & Engel, R. R. (2006). Linking the PANSS, BPRS, and CGI: Clinical implications. Neuropsychopharmacology, 31:2318 – 2325.

 

Varner, R.V., Chen, Y.R., Swann, A.C., & Moeller, F.G. (2000). The Brief Psychiatric Rating Scale as an acute inpatient outcome measurement tool: A pilot study. Journal of Clinica Psychiatry, 61:418 – 21.

 

Svindseth, M. F., Nottestad, J.A., & Dahl, A.A (2010). A study of outcome in patients treated at a psychiatry emergency unit. Nordic Journal of Psychiatry, DOI:        10.3109/08039481003690273.

 

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

 

 

 

 

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Way To Go, Cindy!

 

Congratulations to intern Cindy Geil, for successfully defending your dissertation!

 

 

You are awesome!!

 

 

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Friday Factoids: To Rx or Not to Rx–Psychology’s Ongoing Debate

I went home contemplating this week’s Friday Factoid. Time was pressed and I had no idea what to address. So I turned on my television and tuned in to the local channel 6 news. There it was, a short news story featuring a State of Illinois proposal that would in essence approve psychologists to exercise prescription privileges.

 

Immediately, I said, “Wow, that’s interesting.” I did a search for the local channel 6 website and located the article entitled, “Panel OKs bill to let psychologists prescribe.” According to the Springfield, Illinois (AP), “The proposal was signed off by an Illinois legislative panel recently on a 9-5 vote.” At this time things are looking bright as the proposal heads further along in the full approval process. If this peaks your interest (and I’m sure it has), then take a look at the Illinois website. Once there, look on the left panel and put in the number SB2187 to read a summary of the bill.

 

The debate over prescription privileges has caused differences of opinion among psychologists and other professionals. The local news article (2014 May 8), mentioned that a proponent of the bill, Rep John Bradley, says, “Letting psychologists prescribe drugs would help ease a doctor shortage.” However, opponents from the Illinois State Medical Society say, “Psychologists do not have enough medical training to safely dispense medication.” You can take a look at the fact sheet that was sponsored by the Illinois Psychiatric Society for a more complete summary of their opposition.

 

In closing, in her article, Physicians Fight to keep Psychologists from Prescribing, Melville (2013) expands on this very exciting debate.  More interesting was the fact that she indicated that during the mid 1990s, out of 170 proposals from various states, only three states granted prescription privileges, namely, “New Mexico, Louisiana and Guam.”

Have you considered your position in this ongoing debate?

 

References:
Illinois Psychiatric Society Do you want your medication prescribed by someone who took an online psychopharmacology course? http://www.illinoispsychiatricsociety.org/advocacy/Documents/IPS%20FinalFactSheet%20April%209.pdf

 

Melville , N.A. (2013). Physicians Fight to Keep Psychologists From Prescribing. Retrieved from http://www.medscape.com/viewarticle/781519

 

WPSD Local 6 News, (2014 May 8). Panel OKs bill to let psychologists prescribe. [Television Broadcast]. Retrieved from  http://www.wpsdlocal6.com/story/25465795/panel-oks-bill-to-let-psychologists-prescribe.

 

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

 

 

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