Friday Factoids: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, or PANDAS for short, was a relatively new term that this writer was not very familiar with more than three weeks ago. For those of you like this writer who were unaware that a neuropsychiatric disorder shared its name with a black and white bear, let me share some information. According to the National Institute of Mental Health (NIMH), PANDAS is a “syndrome” which means it includes a number of disorders and issues that share an origin. This list includes tic disorders, obsessive compulsive disorder, anxiety disorders and some mood/behavior issues (PANDAS, 2015).

 

The shared origin of the disorders and issues listed above, in regards to PANDAS, results in the child having contracted a streptococcal infection (strep throat/scarlet fever). Strep is an extremely old bacterium that survives very well due to its ability to hide from its host’s immune system. It brilliantly has a biological cloaking system called molecular mimicry. Essentially, it places molecules on the outer portion of its cell wall that make it indistinguishable from molecules found within the host child’s brain, heart, joint and skin tissues. This allows it to avoid discovery and rapidly multiply unimpeded for some time. When the intruders are finally recognized, they are attacked by antibodies created by the immune system. However, due to the molecular mimicry, the antibodies attack not only the strep molecules but host’s tissue molecules that were mimicked. Therefore, some anti-bodies target the host’s brain tissue specifically. The result of the attack on the brain tissue is what is said to be causing the symptoms of PANDAS (Streptococcus. 2015).

 

The symptoms of PANDAS are vast and can vary from child to child. The symptoms can include: rapid onset or worsening of symptoms already present, a tic disorder and/or OCD, ADHD symptoms (hyperactivity, inattention, fidgety), physical hyperactivity (or unusual, jerky movements that are not in the child’s control), separation anxiety, mood changes (irritability, emotional lability, sadness), sleep disturbance, gross/fine motor changes (such as changes in handwriting or drawing abilities), anorexia or refusal to eat, night-time bed wetting and/or day-time urinary frequency and joint pains. The age if onset is usually anywhere from three years to the beginning of puberty. The child also must have had a positive strep culture or previous history of scarlet fever. It is important to note that the symptoms can go through an episodic course meaning they can cycle in their presence and severity with each new contraction of a streptococcal infection (PANDAS, 2015).

 

Currently, there is not a lab test used in the diagnosing of PANDAS but, as mentioned above, the child must have had a positive strep culture or previous history of scarlet fever and some combination of the majority symptoms. PANDAS is a clinical diagnosis and must meet a set of specific criteria for the diagnosis to be given.  If you believe your child may suffer from the syndrome, then contact your health care provider to discuss your child’s symptoms. Treatment usually consists of one round of antibiotics to eliminate the streptococcal bacterium. Symptoms will then begin to decrease over the course of several days to weeks.

 

Crystal K. Bray,
WKPIC Doctoral Intern

 

Works Cited
PANDAS: Fact Sheet about Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. (n.d.). Retrieved November 29, 2015, from http://www.nimh.nih.gov/health/publications/pandas/index.shtml

 

Streptococcus. (2015). In Encyclopædia Britannica. Retrieved from http://www.britannica.com/science/Streptococcus

 

Washington, H. (2015, November 3). Catching Madness. Retrieved November 29, 2015, from https://www.psychologytoday.com/articles/201511/catching-madness?collection=1081138

 

Crystal K. Bray,
WKPIC Doctoral Intern

Friday Factoids: Islamophobia

At the beginning of the 1990s, the term Islamophobia emerged for the first time in the United States and Great Britain. It is a term used to describe an intense fear, dislike or hate of Muslims. A wealth of misinformation actively promotes Islamophobia in America. Self-reported knowledge, whether accurate or not, about the religion of Islam seems to affect Americans’ feelings of prejudice toward Muslims. Researchers are beginning to explore the impact that Islamophobia can have on the mental and physical health of Muslim-Americans.

 

Muslims constitute approximately 23 percent of the world’s population and serve as a majority in approximately 50 countries. The population of Muslims in the U.S. has grown to more than 2.6 million. Many of them arrived in North America hoping to escape the discrimination and hate occurring in their country. It is important to be aware that Muslims can have various races and ethnicities, since Islam is a religion and not an ethnicity. For example, in America the three largest ethnic Muslim groups are Arab Americans, African Americans and South Asians.

 

Perceptions of the Muslim community have changed dramatically after 9/11. The expected reaction to any terrorism attack is to point the finger at Muslims. Even though less than 2 percent of all terrorist attacks over the past five years have been religiously motivated. An FBI report shows only 6 percent of all terrorism attacks in the U.S. between 1980 and 2005 were committed by Muslims. Research shows that the U.S. identified more than 160 Muslim-American terrorist suspects in the decade since 9/11. That is just a percentage of the thousands of acts of violence that occur in the United States each year. According to the Muslim Public Affairs Counsel, since 9/11, the Muslim-American community has helped security and law enforcement officials prevent nearly two of every five al Qaeda terrorist plots threatening the United States. It is from government prosecution and media coverage that brings Muslim-American terrorism suspects to the national spotlight. As a consequence, many Muslims feel vulnerable.

 

Few studies on Muslim health exist. Most studies identified that daily, repetitive harassment is the biggest factor contributing to long-term mental health issues in Muslim populations. In a 2011 study on Muslim-Americans, researchers found that the vast majority of participants said they felt extremely safe prior to 9/11. Following the attack, 82 percent of them felt extremely unsafe. The researchers later found many of those studied developed Post Traumatic Stress Disorder from constant anxiety and abuse. Mental illness is often stigmatized in Muslim culture. Research by Allen and Nielsen (2002), indicated that one of the best predictors of becoming a victim of discrimination or harassment was being perceived as a Muslim. Having an Arab appearance or wearing specific garments such as a hijab was most closely associated with such incidents.

 

Many Muslims choose prayer or private coping before they seek professional help. Physical or mental illness may be seen as an opportunity to remedy disconnection from Allah or a lack of faith through regular prayer and a sense of self-responsibility (Padella et al., 2012). Imams (traditional spiritual leaders) are often seen as indirect agents of Allah’s will and facilitators of the healing process. Imams may also play central roles in shaping family and community attitudes and responses to illness guidelines, or birth customs (Padella et al., 2012). Many American physicians are not well versed on Muslim culture, including health-related traditions and beliefs like long fasts or end-of-life care. This may discourage many Muslims from seeking treatment.

 

In 2007 the Muslim Council of Britain issued the following statement: “Muslims everywhere consider all acts of terrorism that aim to murder and maim innocent human beings utterly reprehensible and abhorrent. There is no theological basis whatsoever for such acts in our faith. The very meaning of the word ‘Islam’ is peace. It rejects terror and promotes peace and harmony.”

 

 

References:

 

Abdullah, T., & Brown, T. L. (2011). Mental illness stigma and ethnocultural beliefs, values, and norms: An integrative review. Clinical Psychology Review, 31, 934-948.

 

Abu-Ras, W. & Abu-Bader, S. H. (2008). The Impact of the September 11, 2001 Attacks on the well-being of Arab Americans in New York City. Journal of Muslim Mental Health, 3, 217-239.

 

Ali, O. M., Milstein, G., & Marzuk, P. M. (2005). The imam’s role in meeting the counseling needs of Muslim communities in the United States. Psychiatric Services, 56, 2-5.

 

Allen, C., & Nielsen, J. S. (2002). Summary report on Islamaphobia in the EU after 11

September 2001. Vienna: European Monitoring Center on Racism and Xenophobia.

 

Muslim Public Affairs Counsel. (2013). A tracking of plots by Muslim and non-Muslim violent extremists against the United States. Retrieved from: http://www.mpac.org/publications/policy-papers/post-911-terrorism-database.php

 

Padela, A. I., Killawi, A., Forman, J., DeMonner, S., & Heisler, M. (2012). American Muslim perceptions of healing key agents in healing, and their roles. Qualitative Health Research, 22, 846-858.

 

 

Jonathan Torres, M.S.
WKPIC Doctoral Intern

 

Friday Factoid: Sleep is More Than a Symptom

 

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

 

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

 

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

 

 

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

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