Blog - Western State Hospital Internship Program

First Episode Psychosis: A Review of NIMH’S White Paper

Posted on November 25, 2015 by Susan Vaught

The National Institute of Mental Health’s White Paper on evidenced-based programs for first episode psychosis (FEP) suggests treatments which are not currently in place in Western Kentucky. At the time of this article review, twenty states currently have evidence based FEP programs, but Kentucky is not one of them. The Recovery After an Initial Schizophrenia Episode program (RAISE) is an NIMH initiative to investigate early community treatment of FEP, and the RAISE paper discusses an evidence-based model for treatment of FEP that might be beneficial for the State of Kentucky to adopt.

States implementing evidence-based FEP programs provide services that are driven by treatment teams and specific to the developmental tasks of young adulthood. Since a majority of patients experience their first episode of psychosis (FEP) between 15-25 years old, programs are targeted toward teen and early adult populations. Within these evidence-based models, research notes that patients experiencing FEP are in the process of acquiring the social, relational, academic, and vocational skills upon which the rest of their adult life may be built upon—so disruption in this normal developmental process can be catastrophic. The lack of development in these vital areas then contributes to accumulated disability for people with psychotic disorders. The work of other states and countries has provided two decades of research to draw upon guiding program development in the United States This research strongly supports early intervention’s ability to stop the accumulated disability in young people who develop psychotic disorders.

Coordinated Specialty Care (CSC) is the model that has been implemented in other countries and in some areas of the United States. CSC has the potential to mitigate and possibly even stop the damage caused by psychotic disorders. Some elements of the CSC framework exist in Western Kentucky, making the development and implementation of a CSC program a reasonable goal. Other RAISE programs have been embedded into existing healthcare services. CSC resembles the Assertive Community Treatment (ACT) model in some ways but very much differs in others. The presence of ACT teams and community mental health centers may be a starting framework for CSC.

Additional components of CSC include assertive case management, Individual Resiliency Training (IRT) model based psychotherapy, family education and support, supported employment and education services, and low doses of select antipsychotics. CSC emphasizes a youth driven structure, a relationship with a primary staff member, and small caseloads for staff. CSC is a team driven approach involving the patient and family members. Collaborative treatment planning helps to increase compliance with treatment. CSC emphasizes shared decision-making and a therapeutic alliances with patients in order to maintain engagement in the program over time. One CSC staff member is always identified as the patient’s principal care manager.

CSC strives to bridge the gap between hospitalization and engagement in outpatient services. Referred individuals may be interviewed for eligibility while hospitalized and ‘in reach’ services provided. This gives patients a chance to form an alliance with CSC staff prior to discharge. The CSC program then contacts the patient no less than 7 days after discharge to begin program entry. Since there is heavy emphasis on a person-centered, therapeutic alliance approach, primary clinicians should be a first point of contact. Research supports care of up to 5 years post-onset of FEP in order to maintain gains made in treatment. Maintaining engagement over a 5 year period requires a strong collaborative alliance with patients and families. CSC programs should engage in strong outreach activities to schools, emergency rooms, jails and police departments, youth care agencies and any agency in their catchment area having contact with youth. The outreach program must have expertise in relationship formation in order to maintain collaborative relationships with other community agencies and bridge the gaps in care for FEP.

The youth driven structure of CSC means that all aspects of the program need to be tailored to adolescents and young adults. Reception and treatment areas of clinics should be decorated with youth in mind. Some CSC programs have separate waiting areas within existing healthcare clinics to facilitate a comprehensive youth-centered environment. Trends for adolescent and youth populations change more quickly than adult populations, and this should be taken into account when creating the clinic environment. Reception staff should be trained in dealing with youth and their families. Experienced mental health clinic receptionists may have more experience assisting adults with chronic mental illness versus youth experiencing FEP. CSC staff must be highly motivated to work with the complexities of FEP youth and their families. Flexibility is an absolute must. Weekend and evening appointments are necessary with this population in order to accommodate and encourage work and academic schedules. FEP peers who can help direct the youth friendliness of the clinic may provide valuable insight to clinic staff.

CSC provides a comprehensive, evidence based model of FEP treatment. Western Kentucky could benefit greatly from such a program serving youth. CSC programs are likely to decrease the cost of utilization of other community resources including state psychiatric hospitals, medical facilities and criminal justice resources. Infrastructure within current community mental health exists making development and implementation of CSC feasible.

http://www.nimh.nih.gov/health/topics/schizophrenia/raise/nimh-white-paper-csc-for-fep_147096.pdf

Rain Blohm, MS
WKPIC Doctoral Intern

Posted in Blog, Continuing Education, Current Interns, Mental Health and Wellness, Resources for Interns | Tagged community treatment for schizophrenia, FEP, First Episode Psychosis, NIMH, RAISE | Leave a comment

Friday Factoid: Sleep is More Than a Symptom

Posted on November 20, 2015 by Susan Vaught

Americans are notoriously sleep deprived, but those with psychiatric conditions are affected even more. Chronic sleep problems affect 50 percent to 80 percent of patients in a psychiatric setting, compared with 10 percent to 18 percent of adults in the general U.S. population. Sleep problems are particularly common in patients with anxiety, depression, bipolar disorder, and attention deficit hyperactivity disorder. An increasing body of literature is suggesting that clinicians should turn their attention to closely monitor and treat our most basic function.

While we sleep, we progress through five stages of increasingly deep sleep. During this time, body temperature drops, muscles relax, and heart rate and breathing slow. The deepest stage of sleep produces physiological changes that help boost immune system functioning. When a person transitions into REM (rapid eye movement), body temperature, blood pressure, heart rate, and breathing increase to levels measured when people are awake. Studies report that REM sleep enhances learning and memory, and contributes to emotional health. When sleep is disrupted it can affect levels of neurotransmitters and stress hormones, impair thinking and emotional regulation. Poor sleep can lead to health issues such as Type II Diabetes, cardiovascular disease, reduced immunity, or altered endocrine functions. The effects of poor sleep may intensify the effects of psychiatric disorders.

Longitudinal studies suggest that sleep problems worsen before an episode of mania or bipolar depression, and lack of sleep can trigger mania. Sleep problems also adversely affect mood and contribute to relapse. Sleep disruptions in PTSD may contribute to retention of negative emotional memories and prevent patients from benefiting from fear-extinguishing therapies. Problems with sleep are a better predictor of severe depression than thoughts of or wishes for death, feeling of worthlessness and guilt, psychomotor retardation, weight problems or fatigue. Furthermore, individuals identified as “at risk” of developing bipolar disorder and childhood-onset schizophrenia typically show problems with sleep before any clinical diagnosis of illness. Such findings raise the possibility that sleep disruption may be an important factor in the early diagnosis of individuals with mental illness.

Traditionally, clinicians treating patients with psychiatric disorders have viewed sleep disorders as symptoms. But studies in both adults and children suggest that sleep problems may raise risk for, and even directly contribute to, the development of some psychiatric disorders. This research has clinical application, because treating a sleep disorder may also help alleviate symptoms of a co-occurring mental health problem. Neuroimaging and neurochemistry studies suggest that a good night’s sleep helps foster both mental and emotional resilience, while chronic sleep disruptions set the stage for negative thinking and emotional vulnerability. One study managed to reduce sleep disruptions using cognitive behavioral therapy in patients with schizophrenia who showed persecutory delusions and found that a better night’s sleep was associated with a decrease in paranoid thinking along with a reduction in anxiety and depression. It is clear that sleep problems in mental illness is not simply the inconvenience of being unable to sleep at an appropriate time but is an agent that exacerbates or causes serious health problems.

For an interesting video on sleep, check out this TED Talk!

References:

Germain, A. (2008). “Sleep-Specific Mechanisms Underlying Post-traumatic Stress Disorder: Integrative Review and Neurobiological Hypotheses,” Sleep Medicine, 12, 185–95.

Gregory, A. (2009). “The Direction of Longitudinal Associations Between Sleep Problems and Depression Symptoms: A Study of Twins Aged 8 and 10 Years,” Sleep, 32, 189–99.

Krystal, A. (2006). “Sleep and Psychiatric Disorders: Future Directions,” Psychiatric Clinics of North America, 29, 1115–30.

Jonathan Torres
WKPIC Doctoral Intern

Posted in Blog, Continuing Education, Current Interns, Friday Factoids, Mental Health and Wellness, Resources for Interns | Tagged effects of sleep on ADHD, effects of sleep on anxiety, effects of sleep on depression, sleep and mental health, sleep deprivation | Leave a comment

Friday Factoid (Catch-Up): Rural Psychologists Face Additional Ethical Challenges

Posted on November 19, 2015 by Susan Vaught

Many psychologists choosing to work in a rural setting need to negotiate a delicate balance between their specialty setting and the APA ethics code, which was written within an urban context. The APA ethics code is not only important in directing professional behavior, it provides psychologists with a unified professional identity. While there has been some call to write a rural-specific ethics code, creating separate ethics codes tailored to each specialty practice within psychology has the potential to harm the profession as a whole. As such, rural psychologists must find creative ways to maintain adherence to the code of ethics, especially in most likely areas of difficulty: managing potential unavoidable dual relationships, navigating community contacts, and protecting confidentiality related to incidental exposure/contacts (such as visibility of practitioner’s office),

Part of the informed consent processes in a rural community might include discussions about how to handle unavoidable dual roles and likely community contacts. For example, it’s more likely the psychologist’s and patient’s children attend school together at the only elementary school in the area. When the psychologist is the only resource for hundreds of miles referring to another clinician may not be feasible. Patients should be aware of predictable/obvious situations in which they may encounter therapists, and some discussion of how boundaries will be managed in those situations may be necessary.

Additionally, a frank discussion about how the patient prefers community contacts to be handled would be advisable. The patient may prefer that the psychologist not interact with them in order to preserve confidentiality. Conversely, some patients may not understand that a boundary exists during community contact and therapeutic issues cannot be discussed outside of therapy. Without a proactive discussion, these issues can become ethically and therapeutically problematic.

Rural psychologists have many considerations when it comes to protecting patient confidentiality. The location of the psychologist’s office must be considered in towns where many people know one another. Patients may become leery of obtaining treatment if the office is in an easily visible area. When patients know one another, the psychologist may have to manage their own reactions when a patient discloses information about someone else the psychologist is treating, or people the psychologist knows personally and socially. This information, while confidential to the original patient most certainly could affect the psychologist’s work with additional patients, and place some burden on personal interactions as well.

There are of course many other dilemmas that may affect rural psychologists and their practices. Above all, the well-being of the patient and psychologist should guide decisions. Psychologists may consider patients first, but it is crucial they also weigh how handling ethical problems could affect their quality of life in a small community. Having a patient you know is angry with you and has an unpaid bill attending your church is certainly a possibility in a small rural town! Creativity and proactive management are likely to be the best options for management of these issues.

References

American Psychological Association. (2010). Ethical principles of psychologists and code of conduct. Retrieved from http://apa.org/ethics/code/index.aspx

Smalley, K. B., Rainer, J., & Warren, J. (2012). Rural Mental Health : Issues, Policies, and Best Practices. New York: Springer Publishing Company.

Rain Blohm, MS
WKPIC Doctoral Intern

Posted in Blog, Continuing Education, Current Interns, Friday Factoids, General Information, Mental Health and Wellness, Resources for Interns | Tagged ethical challenges in pyschology, psychology practice in rural settings, rural psychology | Leave a comment

Friday Factoid Catch-Up: Self-Care for Psychologists–Ethical and Necessary

Posted on November 19, 2015 by Susan Vaught

Self-Care seems to be a topic frequently addressed with graduate students and psychologists. We often hear these messages, but at the same time mentally run down a list of things we need to do in our head. Often, these mental lists include assignments, research, clients, family commitments and other professional duties and personal obligations. Many conferences and other gatherings of clinicians offer informative talks about self-care, even stressing that it is an ethical imperative and a duty for clinicians to engage in self-care on a routine basis—and yet, those to-do lists still rise up to defeat our attempts to look after our own needs.

Why do psychologists fair so poorly in caring for themselves? Ironically, many of our life experiences, such as trauma or family dysfunction, which may strengthen our work with patients, simultaneously impair our ability to care for ourselves.

I have heard the same suggestions for self-care over and over: exercise, diet, sleep, vacations, etc. I am not always in agreement on suggesting “standard” self-care because I think each psychologist’s life is unique, and so the self-care strategies will be equally unique. I think it may be important for psychologists to develop five or more main self-care activities, and this list probably should evolve over time. Aspects of this list might include insuring that basic physiological needs are attended to as well as personal therapeutic goals. I have yet to see a standard self-care list state a recent addition to my own list, like “learning to accept your mistakes.” It may be that it is easier for a room full of wounded healers to accept a prescription for physically running versus sitting and thinking about accepting imperfection. A lack of exercise and perfectionism both carry a significant cardiovascular disease burden.

The list we make for our self-care should be portable. What I mean by that is, it should be something we can take with us each day. A vacation to Tahiti every day isn’t feasible, but five minutes of visualization practice certainly is. I may not be able to start a fabulous new diet overhaul today but I can try to abide by a general guideline like asking myself if I would feed the meal I’m about to eat to someone I love.

I do believe that self-care is a vital clinical skill, but it is critically important to look at why it is so difficult for psychologists to consistently achieve. The argument of lack of time is simply not valid—or not the only factor. People filling schedules caring for others without investment in themselves have unaddressed issues of one form or another. These issues are unique for each of us, and a deeper exploration of the reasons for self-neglect may prove to be a worthwhile personal and professional endeavor.

References
Barnette, J.E. (n.d.). Psychological wellness and self-care as ethical imperative. Retrieved from http://www.apa.org/careers/early-career/psychological-wellness.pdf

Rain Blohm, MS
WKPIC Doctoral Intern

Posted in Blog, Continuing Education, Current Interns, Friday Factoids, Mental Health and Wellness, Resources for Interns | Tagged Self-care for psychologists, self-care in mental health | Leave a comment

Article Review: Posttraumatic Stress Disorder in DSM-5: New Criteria and Controversies

Posted on November 17, 2015 by Susan Vaught

As our knowledge of mental health issues continues to increase, The Diagnostic and Statistical Manual for Mental Disorders (DSM) must consistently update its analytic and disorder-specific criteria. It is essential to do so to ensure not only its relevance, but also its championing of the most current and accurate diagnostic information available. Each update or manual revision has the potential to create controversy or difficulties with implementation in practice. Miller, Wolfe and Keane (2014) recognized that the fifth and latest revision of the DSM (DSM-5) was no exception, especially with respect to the diagnosis of Posttraumatic Stress Disorder (PTSD). Additionally, new controversy has erupted related to the upcoming International Classification of Diseases, Edition 11 (ICD-11) (Miller, Wolf & Keane 2014).

Moving PTSD
Miller, Wolfe and Keane identified the removal of PTSD from the Anxiety Disorders chapter and into a new one titled “Trauma- and Stressor-related Disorders” as the most substantial and potentially controversial move made in the new revision. PTSD had previously been included with anxiety disorders, since its introduction in the DSM-III, even though some were apprehensive with the placement. The newly created chapter in the DSM-5, that now houses PTSD, was formulated to better reflect the heterogeneity of psychological distress found in samples of individuals exposed to serious adverse life events (Miller, Wolfe & Keane, 2014).

The researchers found that in the beginning, most developments related to PTSD came about because of its close association with anxiety disorders. They then noticed that as studies progressed, symptomology, as well as the backgrounds of those diagnosed with PTSD, revealed that re-experiencing the event was the key symptom. The majority of research they reviewed clearly identified fear and anxiety as being present and essential to varying degrees in the development of PTSD, but further noted that reliving the event was the principal complaint. (Miller, Wolfe & Keane, 2014).

The arguments against the move note that effective treatment for PTSD focuses on fear and anxiety. Therefore, many still believe that PTSD should be included under the meta-structured chapter of Anxiety Disorders. Our researchers disagree and explain that the DSM-5 even notes that anxiety and fear are more prominent for some patients than others, but are required symptomatology for all who are diagnosed with PTSD. (Miller, Wolfe & Keane, 2014).

Criterion A Changes
Miller et al (2014) listed several changes that were made to the definition of trauma (Criterion A). First, the types of involvements considered to be traumatic have been more specifically identified as sexual violence, serious injury or exposure actual or threatened death. “Exposure” can be in the form of direct contact, being a witness to the event, hearing about the event if it happened to those close to the person, and/or repeated exposure, such as what a trauma counselor would experience. The change in this information is to better clarify and differentiate from events that are life-altering but not traumatic.

A second change to Criterion A was the elimination of A2. It was a list of emotional responses that the person must have felt regarding the event. Study data revealed that the list was irrelevant to diagnosis because many persons do not experience those emotions at the time of the event. Therefore, since it was not purposeful to diagnosis, it was not needed as criteria for the disorder.

The third and final change to Criterion A was the wording of the language. With the change of traumatic “event” to “event(s)”, PTSD symptoms related to more than one trauma can now be diagnosed. It also made a diagnosis possible for those individuals who would not have met the criteria through one single event. Additionally, patients who have endured multiple traumas can include the events and symptoms as a collective instead of linking them to one isolated event.

Revision to the Specific Symptoms that Define PTSD
Miller et al. (2014) noted that adding three new symptoms to PTSD criteria, four symptom clusters instead of three, and adding a new diagnostic algorithm was the most palpable change. The first of the three new symptoms to be added was having “distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.” The second is a “persistent emotional state.” Both of these symptoms can be found in Criterion D. The final symptom added to the DSM-5 was “reckless or self-destructive behavior” and it is in Criterion E. (DSM-5)

In mentioning the above symptoms, it is easy to note that Criterion E is the newly added symptom cluster. In addition to this cluster, the previous ones received modifications as well. Cluster B was only minimally effected with the change in wording from “re-experienced” to “intrusion.” Criterion C was aptly named “persistent avoidance of a stimuli associated with the traumatic event(s) and was derived from a combination from C1 and C2 from the previous DSM version. “Negative alterations in cognitions and mood that are associated with the traumatic event” was the term given to Criterion D. The new Criterion E was actually the hyperarousal cluster from the previous DSM-IV. It received a new title known as “alterations in arousal and reactivity that are associated with the traumatic event(s).” (Miller, Wolfe, & Keane, 2014).

The new diagnostic algorithm was one of the last changes noted by Miller et al. (2014). This algorithm indicates that to meet a PTSD diagnosis, an individual has to experience at least one symptom in both Criterions B and C as well as two symptoms in each Criterions D and E.

Initial Studies Examining the Impacts of these Changes
Miller et al. (2014) reviewed data from numerous empirical studies comparing and contrasting the occurrence of PTSD in the general population, veterans, college students and earthquake survivors. They found that in the initial studies that compared event exposure in the general population for prevalence estimates for a lifetime (L) and past six months (6M) were somewhat lower when defined in by the DSM-5 (L=8.3, 6M=3.8) when compared to the defined criteria in the DSM-IV (L=9.8, 6M=4.7). However, additional research and studies demonstrated that the DSM-5 was providing minutely higher approximations than the DSM-IV. Once study noted by our authors indicated that the when 185 volunteers were administered a revised version of the PTSD Scale, 50% met criteria for PTSD when assessed using the criteria in the DSM-IV and 52% met the criteria when using the DSM-5 (Calhoun, et al, 2012). The last study mentioned in the article utilized the college student population. It measured for students who would actually be clinically diagnosed with moderate functional impairment due to PTSD symptoms. Using the DSM-5 criteria, the prevalence estimate was 4.8% and 4.3% using the DSM-IV. Statistically, there was less than a one percent difference and deemed that DSM-5 had “no substantial” effect on prevalence when compared to the DSM-IV (Miller, Wolfe, & Keane, 2014).

Additionally, Miller et al. (2014) studied the configuration of factor loadings in the DSM-5 model. They found that the “amnesia” symptom and “new/reckless/self-destructive behavior” symptoms resulted in “weaker loadings on their respective factors in CFA (Miller, Wolfe & Keane, 2014). In further exploration, they identified a link between those who endorsed these symptoms and increased levels of PTSD.

Rater reliability was also analyzed. The findings were quite favorable. They suggested that even those professionals with moderate experience using the DSM-5 diagnostic criteria for PTSD were producing reliable diagnoses (Miller, Wolfe, & Keane, 2014).

The Dissociative Subtype of PTSD
A new dissociative subtype was added to the DSM-5 that included the features of derealization and/or depersonalization. The addition of this subtype is deemed controversial by some because there is still a debate of sorts as to whether or not the symptoms are basic features of PTSD or those that are experienced by a subset of individuals only. Miller et al. (2013) were the first to conduct a study utilizing latent profile analysis with the subtype and its correlation to PTSD. Using CAPS (Blake et.al., 1995), they assessed a sample group of veterans and their partners. Three distinct groups emerged from their data: 1) low PSTD severity and no derealization/ depersonalization 2) high PTSD severity and no derealization/depersonalization 3) high PTSD severity (equal to group 2) and discernible symptoms of derealization and/or depersonalization. The third group is now titled as the dissociative subtype group (Miller, Wolfe, & Keane, 2014).

Patients who meet the criteria for the dissociative subtype experience more recurrent and forceful flashbacks, are more likely to have a history of sexual abuse, suffer psychogenic amnesia, psychiatric comorbidity, suicidal ideation and functional impairment (Miller, Wolfe, & Keane, 2014). Additionally, those linked with this subtype were found to experience an over-modulated reaction to trauma cues so much so that the frontal brain regions dynamically inhibit the limbic brain regions that are profoundly associated in emotional responsivity. Fear was found to be the emotion most responsible for this reaction (Lanius et al., 2012). Miller et al. (2014) noted that the inclusion of this subtype into the DSM-5 provided a greater reliability in the conceptualization of dissociation across PTSD studies and diagnosis.

Conclusion
The diagnosis of PTSD continues to be surrounded by controversy. The new changes made in the DSM-5 have only worked to lengthen the debate for some. However, preliminary studies indicate that the modifications have not had a considerable effect on the approximations of PTSD prevalence. Likewise, the reliability of diagnosis using a clinical assessment has not experienced a significant effect due the changes, either.

References
Lanius, R. A., Brand, B., Vermetten, E., Frewen, P. A., & Spiegel, D. (2012). The dissociative subtype of posttraumatic stress disorder: Rationale, clinical and neurobiological evidence, and implications. Depression and Anxiety, 29, 701–708. doi:10.1002/da.21889

Miller, M., Wolf, E.J., & Keane, T. (2014). Posttraumatic Stress Disorder in DSM-5: New Criteria and Controversies. Clinical Psychology: Science and Practice, 21(N3), 208-220. doi:10.1111/cpsp.12070

Miller, M. W., Wolf, E. J., Kilpatrick, D., Resnick, H., Marx, B. P., Holowka, D. W., Friedman, M. J. (2013). The prevalence and latent structure of proposed DSM-5 posttraumatic stress disorder symptoms in U.S. national and veteran samples. Psychological Trauma: Theory, Research, Practice, and Policy, 5, 501–512. doi:10.1037/a0029730

Trauma and Stressor Related Disorders. (2013). In Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). Washington, D.C.: American Psychiatric Association.

Crystal Bray, BS
WKPIC Doctoral Intern

Posted in Blog, Continuing Education, Current Interns, Mental Health and Wellness, Resources for Interns | Tagged Changes in PTSD Diagnosis, DSM-5 changes, DSM-5 PTSD | Leave a comment

Friday Factoid- Rising Mortality Rates for Middle-Aged White Americans

Posted on November 13, 2015 by Susan Vaught

Case and Deaton (2015), both economists from Princeton, found that mortality rates for middle-aged white Americans have risen since 1999. In contrast, the death rate for middle-aged blacks and Hispanics continued to decline during the same period, as did death rates for younger and older people of all races and ethnic groups. They analyzed health and mortality data from the Centers for Disease Control and Prevention and other sources.

First, the authors ruled out an increase in deaths from chronic diseases such as heart disease, cancer, and diabetes. Those numbers were all either stable or trending downward. Murder and accidents were also declining. The authors concluded the rising annual death rates among this group are being driven by an epidemic of suicides. Most of the drug-related deaths in America are now caused by prescription medicines, and nearly three-quarters of those deaths are from opioid painkillers. Reliance on opioid painkillers is an epidemic that started in the late 1990s. Chronic liver diseases related to drug and alcohol use in this group were also on the rise.

Studies have found white patients with pain are more likely to be prescribed opioid painkillers. And whites have been more likely to attempt suicide when faced with physical or mental hardships. The New York Times reported 90 percent of people who tried heroin in the last decade were white. Drug addiction in black communities ultimately resulted in mass incarceration, while heroin and prescription drug abuse has been met with a more sympathetic approach, possibly because its victims are white. The only other time that death rates increased among middle-aged whites in the last century was in the 1960s because of smoking-related diseases. There was also a spike in mortality among younger adults in the 1980s during the AIDS epidemic.

One possible factor behind the substance abuse is this demographic group has faced a rise in economic insecurity over the past decade, driven by things like the financial crisis and the collapse of manufacturing. Education is also a factor. The effect was largely confined to people with a high school education or less. In that group, death rates rose by 22 percent while they actually fell for those with a college education. Mortality among the middle-aged population plummeted in the six other countries that the authors examined: Australia, Canada, France, Germany, United Kingdom, and Sweden. Although these countries also had economic problems in recent years, its residents might have been less affected because they have more social safety nets in terms of unemployment benefits and health care.

References:

Case, A. & Deaton, A. (2015) Rising morbidity and mortality in midlife among non-Hispanic Americans in the 21st century. Proceedings of the National Academy of Sciences. Retrieved from http://www.pnas.org/content/early/2015/10/29/1518393112.full.pdf

Gold, A. (2015, November 4). Why is death rate rising for white, middle-aged Americans? BBC News, Washington. Retrieved from http://www.bbc.com/news/world-us-canada-34714842

Kolata, G. (2015, November 2). Death Rates Rising for Middle-Aged White Americans, Study Finds. The New York Times. Retrieved from http://www.nytimes.com/2015/11/03/health/death-rates-rising-for-middle-aged-white-americans-study-finds.html

Storrs, C. (2015, November 4). Death rate on the rise for middle-aged white Americans. Retrieved from http://www.cnn.com/2015/11/03/health/death-rate-middle-age-white-americans/

Jonathan Torres, M.S.

WKPIC Doctoral Intern

Posted in Blog, Continuing Education, Current Interns, Diversity In Practice, Friday Factoids, Mental Health and Wellness, Resources for Interns | Leave a comment

Understanding Peer Support as a Profession

Posted on November 11, 2015 by Susan Vaught

“Recovery is a process of change through which an individual improves one’s health and wellness, lives a self-directed life, and strives to reach their full potential.” This is the current definition of “Recovery” according to the Substance Abuse and Mental Health Services Administration (SAMHSA). It is a broad definition, but an inclusive one. Full potential varies from person to person. Living a self-directed life can be tough.

What is the role of Peer Support in promoting this definition? For the most part, Peer Specialists are in what is called Recovery. It was once mandatory that the specialist be in recovery for two years which meant out of the hospital and with active and successful self-care. Now, because of the demand of these certified people, the rules have become a little more forgiving for those wanting to reach out to others in order to help promote hope. There is no definitive time frame that an individual must wait to be a Peer Specialist.

Peer Support is reciprocal. The specialist tries to use the skills he or she has learned to help those struggling, but the act of supporting another person helps the specialist out as well. It gives a purpose and a reason to interact with other people. It reminds one what is was like to be in that vulnerable time when first diagnosed; the difficulty in finding the right medication and support is a roadblock to many, and Peer Specialists know that and understand.

Peer Support has been shown to help in the process of recovery for those with serious mental illness. Some Peer Specialists work exclusively with those struggling with substance abuse problems. There are also programs for specific populations, including Veterans. With the requirement of continuing education, Peer Specialists must stay on top of current issues concerning mental health. The program is quickly spreading in popularity, especially since it is now Medicaid billable. For any questions, or if you know of a patient that may eventually enjoy providing such services, just let me know.

Rebecca Coursey, KPS
Peer Support Specialist

Posted in Blog, Continuing Education, General Information, Information About Peer Specialists, Resources for Interns | Tagged peer support, Recovery | Leave a comment

Friday Factoids: Psychedelic-Assisted Therapy a Paradigm Shift in Mental Health?

Posted on November 6, 2015 by Susan Vaught

In 1938, Albert Hoffman synthesized lysergic acid diethylamide (LSD). After accidentally ingesting it in 1943 he deemed it the “medicine of the soul.” Psychedelic drugs carry a stigma and it is easy to have very different views about them. Some have long claimed that, when taken responsibly and with the proper supervision, psychedelics like LSD and psilocybin are safe to consume. These drugs were researched extensively in the 1950s and 1960s, but funding stalled when the substances were classified as dangerous and lacking medical value. The Controlled Substance Act of 1970 classified psilocybin, LCD, and MDMA as Schedule 1 substances, which is defined as having “no currently accepted medical use and a high potential for abuse.” Interestingly, approximately 0.005% of emergency department visits in the US involve LSD or psilocybin according to the US Department of Health and Human Services.

A growing body of evidence is beginning to show that psychedelics have therapeutic potential beyond what pharmaceutically made prescription drugs can do. A recent article published in the Journal of Psychopharmacology highlights the potential of LSD, psilocybin, and MDMA for treating a wide range of mental illnesses. Several other studies have shown positive results can come from short courses or single sessions of psychedelic-assisted psychotherapy. A study conducted for cigarette smoking at Johns Hopkins had a very high success rate with 80% of people was abstinent after six months after using psilocybin. A pilot study found a strong affect with alcoholism as well. In 2014, Swiss researchers studied the therapeutic benefits of LSD-assisted therapy in reducing anxiety in 12 patients who had been diagnosed with life-threatening illnesses. One year later, nearly all patients showed sustained reductions in anxiety with no adverse reactions. Lastly, one pilot study on 19 participants with drug-resistant PTSD showed a “significant and sustained-reduction in PTSD symptoms” in 83% of those given MDMA-assisted therapy.

The data suggest it’s the nature of the subjective experience that one has while under the effects of the substances that make psychedelics affective. Gasser P, Kirchner K, & Passie T (2015) study found the following:

Evaluations of subjective experiences suggest facilitated access to emotions, confrontation of previously unknown anxieties, worries, resources and intense emotional peak experiences. The experiences created led to a restructuring of the person’s emotional trust, situational understanding, habits and worldview.

Johansen and Krebs (2015) wrote:

Psychedelics are not known to harm the brain or other body organs or to cause addiction or compulsive use; serious adverse events involving psychedelics are extremely rare. Overall, it is difficult to see how prohibition of psychedelics can be justified as a public health measure.
Continued research into psychedelic drugs may one day offer new ways to treat mental illness and addiction. The emerging paradigm shift of psychedelics in a therapeutic setting may open new doors.

References:

Gregoire, C. (2015, September 16). Psychedelics Could Trigger A ‘Paradigm Shift’ In Mental Health Care. The Huffington Post. Retrieved from http://www.huffingtonpost.com/entry/psychedelics-mental-health-care_55f2e754e4b077ca094eb4f0

Johansen, P. and Krebs, T. (2015). Psychedelics Not Linked to Mental Health Problems or Suicidal Behavior: A Population Study. Journal of Psychopharmacology. 1-10. doi: 10.1177/0269881114568039

Gasser P, Kirchner K, & Passie T (2015). LSD-assisted psychotherapy for anxiety associated with a life-threatening disease: a qualitative study of acute and sustained subjective effects. Journal of Psychopharmacology, 29 (1), 57-68

Rivas, A. (2015, March 15). Psychedelics May Improve Mental Health Disorder, But We’ll Have to Support the Research to Find Out. Medical Daily. Retrieved from http://www.medicaldaily.com/psychedelics-may-improve-mental-health-disorders-well-have-support-research-find-out-325780

Jonathan Torres, M.S.
WKPIC Doctoral Intern

Posted in Blog, Continuing Education, Current Interns, Friday Factoids, Resources for Interns | Tagged paradigm shift, psychedelic-assisted therapy, psychology | Leave a comment

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