Bernards Voices

Prof. Murray B Stein MD and Prof. Dan J Stein MD, in The Lancet, Volume 371, Issue 9618, Pages 1115 – 1125, 29 March 2008.

Abstract:

Our understanding of social anxiety disorder (also known as social phobia) has moved from rudimentary awareness that it is not merely shyness to a much more sophisticated appreciation of its prevalence, its chronic and pernicious nature, and its neurobiological underpinnings. Social anxiety disorder is the most common anxiety disorder; it has an early age of onset—by age 11 years in about 50% and by age 20 years in about 80% of individuals—and it is a risk factor for subsequent depressive illness and substance abuse. Functional neuroimaging studies point to increased activity in amygdala and insula in patients with social anxiety disorder, and genetic studies are increasingly focusing on this and other (eg, personality trait neuroticism) core phenotypes to identify risk loci. A range of effective cognitive behavioural and pharmacological treatments [SSRIs] for children and adults now exists; the challenges lie in optimum integration and dissemination of these treatments, and learning how to help the 30—40% of patients for whom treatment does not work.

Listen to the podcast (interview starts at minute 6:00).

My notes from the podcast–bolded items in abstract plus:

• like sadness vs depression, shyness vs social anxiety exist on a spectrum, and it is the “most shy person you know” where this disorder may interfere with their life, and is worth treatment.
• diagnosable in 5% of the population
• easy to diagnosis.  physician/therapists asks: “Does you shyness interfere with your life?”  A yes answer is a strong predictor.
• stigma:  eg. General Physicians often themselves consider it trivial

Also in the issue Simon Wessely provides a dissenting view, reviewing How shyness became social phobia by Christopher Lane.

Pathologising shyness, eccentricity, or sadness does few any favours—neither those who receive unhelpful labels, nor those with major mental disorders who need all the resources and research we can muster.

Slate’s Hang Up and Listen podcast, April 18th, covers 3 topics, including Justin Duchscherer’s depression. Fast forward to minute 33:30–although I enjoy the whole podcast–but it is the last segment which deals with Baltimore Orioles pitcher Justin Duchscherer’s battle with depression. They spend a lot of time talking Joe Posnanski’s article in 2009 Sports Illustrated on Zach Grienke who suffered from anxiety disorder.

An excerpt from Pat Jordan’s Men’s Journal article on Justin Duchscherer.
Jordan’s 2001 New York Times Magazine article on Rick Ankiel.
A 2010 Sports Illustrated feature on baseball players with depression.
The Reds’ Joey Votto missed part of the 2009 season with anxiety problems.
Dontrelle Willis and Khalil Greene have also suffered from social anxiety disorder.

These topics are covered in other HUAL podcasts. They do the best job–i.e. in the context of entertaining discussion about sports–covering mental illness in sports, and sports psychology–dealing with pressure on the soccer or hockey goalie, the pitcher, the field goal kicker.

Another example from Slate, in the HUAL October 25, 2010, podcast, Brandon Roy went to see a sports psychologist this summer.

The Healthy Outcomes Partnership, an initiative of the Somerset Hills YMCA and coalition of agencies, organizations and concerned individuals, is joining with the Mental Health Association in New Jersey to present the second annual Mental Health Week, May 9 – 13. Five days full of talks and workshops on a broad range of topics related to achieving mental and emotional health and well-being. It’s free and open to the entire community. More than 20 national and local experts in behavioral health, family/couple dynamics, child and teen development and elder care will provide current information and resources on timely topics at various times throughout the week at the Somerset Hills Y, 140 Mt. Airy Road, Basking Ridge.

Here is the schedule for the year’s Mental Health awareness week:

Mental Health Week Schedule at a Glance!.

I’d like to highlight Bryan Gibb’s talk on Mental Health First Aid, Wednesday, May 11, 2pm.

If you’ve been following my blog posts, you will know that I’m very personally and passionately committed to the topic. We want to make MHFA as common as CPR first aid. We have 2 of the 10 certified instructors in New Jersey who can provide 12 hour training to members of the general public. I want members of the general public, people like you and I, to know how and when to pick the phone and make that first phone call for help. It is only people very close to the distressed person (a family member, a close friend, a colleague / supervisor at the office) that is in a position to notice the change over time and conclude something like—“my husband/girl friend/employee is not the same person that they were six months ago.”

Learning to Listen to Distressed Classmates – NYTimes.com. Abigail Sullivan Moore reports Friday, April 15th.

“I can tell the difference between someone tired who has a lot of work and someone who is dreading the next 24 hours, the next week,” observes Mr. Sullivan. “It’s kind of like there’s no light at the end of the tunnel for them. It’s not like ‘I’m going to take this test and it’s going to be over’ and there’s a sense of relief.”

Mr. Sullivan has learned to listen for whispers of despair and to reach out to such students before things get worse. He is one of about 250 students in the Student Support Network, a program that teaches them how to get help for troubled friends and acquaintances.

The training from Student Support Network sounds a lot like the Mental Health First Aid training that the SHYMCA is going to roll out.  We now has 2 of the 10 certified MFHA instructors in New Jersey.

And they practice, practice, practice how to gently persuade another student in distress to go for professional help, even if it means walking them to the counseling center.

Both MHFA and this Student Support program are not just about education and awareness, the teach a member of the general public how to act. At the risk of being incredibly repetitive in this blog, it is only those close to the distressed person (family, friends, colleagues) whot can see the change over time, and can conclude, hey, this is not the same person I know. That’s why, like CPR, we want to reach everyone in the community with this first aid training.

There will be a presentation on this during our Mental Health week upcoming May 9th though 12th, 2011 at the Somerset Hills YMCA.

A group of Drew University students has taken it upon themselves to fight the stigma associated with mental illness. “DV8″ will appear at Mental Health Week at the Somerset Hills YMCA during the week of May 9. A link to an article about them is http://www.drew.edu/news/2011/02/14/erasing-the-stigma-of-mental-illness

Stated succinctly, meditation helps people change by teaching them to be inside their experience and simultaneously outside, watching it with perspective. By being in the moment without feeling overcome by emotion, people can become adept at seeing themselves repeat patterns. Then, while acknowledging and experiencing an old pattern, they can choose to respond differently. It’s in this way that meditation frees people to make the personal changes they so desire.

via How to feel good – or at least stop feeling bad | Psychology Today:  Dr. Leslie Becker-Phelps’s blog.

Using more comprehensive data to nail down economic trends, the new study found a clear correlation between suicide rates and the business cycle among young and middle-age adults. That correlation vanished when researchers looked only at children and the elderly.

via Study Ties Suicide Rate in Work Force to Economy – NYTimes.com.

But this study should give communities and doctors a better sense not only of when risk is high, but in whom — working-age adults, in this case. “Once people age out of the work force, there seems to be no relationship between the business cycle and their vulnerability,” Dr. Florence said.

Are Allergies and Depression Related? – NYTimes.com.  Anahad O’Connor reports April 11th–right about the time my morning sneezing kicks in.

While there’s no firm evidence that allergies cause depression, large studies show that allergy sufferers do seem to be at higher risk of depression.

1. “Severe allergies can bring sleeplessness, headaches, fatigue and a general feeling of physical depletion, all of which can worsen mood.”

2. “Studies have found that allergic reactions release compounds in the body called cytokines, which play a role in inflammation and may reduce levels of the hormone serotonin, which helps maintain feelings of well-being.”

And 3. “it’s well known that some common allergy medications, like corticosteroids, can cause anxiety and mood swings.”

On WNYC April 1, Leonard Lopate discusses the roots and consequences of anger with Dr. Philip Muskin, Professor of Clinical Psychiatry, Columbia University Medical Center, and Dr. Howard Kassinove, Professor of Psychology and Director, Institute for the Study and Treatment of Anger and Aggression.

Listen to the podcast:

Here are my notes:

• fear and anger are closely intertwined–central to our fight or flight response
• anger can be constructive, protecting, motivating righting wrongs
• the same trigger, eg. someone taking our parking place, can be perceived and responded to differently on different days, by different people.  do we, cognitively, perceive the triggering event as a threat or an annoyance?
• our brains our wired (nature & nurture) and some people are better at controlling impulses than others
• if you are sad or depressed, everything may feel like a threat to you
• alcohol can have that same effect
• anger is different from aggression.  anger, the emotion, has components of ideas about how bad things are, ideas about revenge.  where aggression is the behavior, the action.  in one of the doctor’s studies:  only 10% of anger events are followed by an aggressive action, but most aggressive action is proceeded with anger.
• people with high self esteem become angry–not people with low self esteem
• Alzheimer’s: “some people get angrier than they usually were” … the way the brain talks to itself is destroyed by Alzheimer’s, so, for example, the patient may loose some of their ability to control, moderate their response
• bipolar and anger relationship? anger is a component of a wide variety of disorders, including bipolar, but the linkage is unclear right now
• anger management: listener asks about children’s temper tantrum? … “you let them grow up”
• anger is part of who we are.  as we mature we learn to regulate anger’s intensity, duration, and frequency… so that we can become productive members of society.  who teaches us? parents, cartoons, friends, teachers, religious institutions.
• repression: catharsis is not a good idea, can amplify the emotion … no good to hold it in or to punch it out … the solution is “verbal assertion” … “communicate assertively”
• internet (because the other person is not right in front of you) is so impersonal that it makes it possible for people to express things inappropriately

December 23, 2009: Neuropod podcasts.

At minute 17:53 in the podcast, there is an interest discussion on how fear memories can be replaced with safer memories. This relates to future, cognitive behavioral therapies, for disorders like PTSD.

Here is a link to the related article in 12/9/09 Nature.

The authors tweaked the timing of extinction therapy so they could take advantage of the fragile reconsolidation period — a window of malleability that opens about three minutes after the memory is reactivated, but closes a few hours later.

Meanwhile, people who got the extinction training 6 hours — instead of 10 minutes — after the reminder, or who got no reminder at all, still showed a significant fear response the next day and the next year.