Medication: The Cost Effective Therapy

Finally, there’s more research suggesting the need to reduce the over-medicating of mental illness, specifically depression. The study conducted by Irving Kirsch of the University of Hull discovered that the benefits of anti-depressants, such as fluoxetine (Prozac), venlafaxine (Effexor), nefazodone (Serzone), and paroxetine (Seroxat / Paxil), are dependent upon the severity of the mental illness.

The study used a meta-analysis of data retrieved from trials supplied by the US Food and Drug Administration. “When the data from all of these trials had been put together, the improvement in depression amongst patients receiving the trial drug, as compared to those receiving placebo (dummy tablets), was not clinically significant in mildly depressed patients or even in most patients who suffer from very severe depression” – Article

It comes as no surprise that only a small group of participants actually benefited from their medications, and these patients tended to be those who suffered from severe depression to begin with. The severely depressed reaped fewer benefits from the placebo and more benefits from the actual medication than those less depressed. This not only suggests that anti-depressants serve their purpose for those who are really suffering, but it clearly demonstrates that not everyone needs to be medicated to function. Over-medicating is a serious problem within our society because it does seem easier to slap on a Band-Aid as opposed to working through months or even years of therapy. Unfortunately, the social and monetary cost of clinical therapy does not seem plausible for everyone in our society, however it hardly seems ethical or even productive to convert the depressed into addicts.

In my opinion, medication should always be the last resort when alternative measures are more proficient in treating mental illness.

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Deal Or Squeal

In recent news, Ottawa’s police Chief, Vern White has made some absurd statements with respect to drug dealing and welfare fraud. His force has decided to report a little over 100 drug dealers to welfare officials for fraud investigations in hopes of having them cut off social assistance. His views are portrayed in a manner that support the greater good of society by saying: “Our focus here, first of all, is to stop people from dealing drugs but secondly to ensure social assistance is provided to people for the right reasons and not for those people who continue to sell drugs and lie about their income”.

On the surface, this act appears to be appealing to the so-called tax payer, however if you glance beneath it seems that there is an ulterior motive. What impact would these sorts of headlines have? Is it really to scare the fraud out of other abusers? Is it to encourage the low-level dealers, who are likely barely surviving at the poverty level with their monthly social assistance cheque to cease taking in that extra cash under the table? Of course, fraud is never legal, but who in their right mind would report income from drug dealing. Some of these dealers may even be dealing to support a drug habit, a poverty stricken family, or even to cover a necessary medication not covered through a drug plan. Whatever the reason may be, threatening to cut their Ontario Works cheque is hardly fighting the war on drugs. Petty dealers are a dime a dozen.

The Chief may have an interesting strategy, but I hardly think he’s aiming at saving tax payer dollars. It seems that the real reason for this announcement is to coerce drug dealers into snitching on their suppliers. The president of the Defence Counsel Association of Ottawa, Mark Ertel, makes an interesting assumption: “You can either become an informant for the Ottawa police or you can be reported for committing welfare fraud”. Article

Granted this might have some impact on the drug epidemic, but the means is through blackmail. Drug dealers may not be the most upstanding citizens; however this type of strategy leaves no room for assistance for these individuals who may be suffering from addiction. Additionally, these addicts who are reported for fraud may stop milking the system, but they may begin committing other crimes to make up for that lost money.

The money these dealers make from committing welfare fraud certainly pale in comparison to the money that flows through the hands of those controlling the drug trade.

Article

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Family Day: Ontario's New Stat Holiday

Today is Ontario’s first statutory holiday which celebrates the family. Our Premier Dalton McGuinty officially introduced this holiday after some 20 years of anticipating another day off. In our society work consumes a large majority of our time and energy.

In a time of constant change and the advent of newer technology which supposedly makes our lives easier, one would think that there would be much more time for family, however this is not the case at all. There is a huge pressure on workers to climb the corporate ladder and earn more money not only to survive but to make sure our family survives well. In 2005, Statistics Canada found that 40% of stressed out men and women attributed their strain to work pressures and the next 10% attributed their source of stress to money struggles.

Although, the province of Alberta has been profiting from this holiday for nearly 20 years now, many people, especially those who aren’t able to benefit from the time off, disagree with the introduction of this new holiday. A single day off means a few hours of work lost, however this doesn’t have to imply a loss in productivity. This leave allows workers the time to revitalize and de-stress in order to better cope with tomorrow. In actuality, the break may not only sustain productivity, but manage to improve it. This day represents a long overdue concern for our society’s mental health and if we’re fortunate enough we can even spend it with family.

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Assessment of Trichotillomania

The following is a snippet of a recent paper that I have written regarding a disorder that seriously lacks attention:

“Late at night, I sit at the end of the sofa, pull the shade off the lamp and allow the bright light to expose hundreds of beautiful hairs. My focus is intense and with great concentration, I locate very fine hairs and pluck them. This gives me great pleasure and the sharp pain relaxes me. The concentration takes me away. I love releasing the once buried little hairs and pulling them. With great luck, I find the thick hairs, some with their black sac still attached. I save those hairs like trophies carefully laying them along the arm of the sofa, black against white. […] now I go to bed exhausted but satisfied.” (Penzel, 2003, p. 10)

This scenario depicts the experience of some sufferers of trichotillomania. The term can be traced back to 1889 when it was first defined by French physician Halipeau (Long, Miltenberger & Rapp, 2006, p. 133). The term itself is Greek in origin; trich refers to hair, tillo refers to pull, and mania refers to madness (Penzel, 2003, p. 2). There is a tendency for this disorder to be more common among females and to develop in childhood or early adolescence (Long et al., 2006, p. 137). Trichotillomania is also commonly associated with other disorders such as mood or anxiety (Long et al., 2006, p. 138). Common areas of pulling are the scalp, eyebrows, eyelashes, face, limbs, and pubic area (Penzel, 2003, p. 8). The physical and emotional costs of this disorder can be debilitating. A number of physical consequences may include calluses on finger tips, strain injuries such as in the neck and back, infections such as on the eyelids and pubic area, and the development of gastrointestinal problems from the swallowing of hair or what is called trichophagy (Penzel, 2003, p. 4). Subsequently, “feelings of shame, helplessness, isolation, and frustration can take a tremendous toll on sufferers” (Penzel, 2003, p. 5). Although, it is estimated to affect roughly 2.5 million people in the United States, the actual rate of occurrence is often inaccurate due to misdiagnoses and extraordinary attempts at disguising or concealing the disorder (Kelly, McCormick & White Kress, 2004, p. 2). The fourth edition of The Diagnostic and Statistical Manual of Mental Disorders currently groups trichotillomania with other Axis I impulse control disorders such as pyromania and kleptomania and is defined by the following criterion:

A. Recurrent pulling out of one’s hair resulting in noticeable hair loss.
B. Feeling of tension immediately before pulling hair out or when attempting to pull hair out.
C. Sense of pleasure, gratification, or relief when pulling out hair.
D. Hair pulling is not better explained by the presence of some other disorder.
E. Hair pulling causes significant distress and an impairment of the ability to function in an important area of one’s life. (Penzel, 2003, p. 2)

The assessment of trichotillomania is conducted through several non-standard and standard measures. The initial interview establishes the baseline and allows the clinician to gather a complete picture of the presenting behaviour and its effect on the individual’s life. Standardized tests help to assess the severity of the disorder; however there is an obvious deficiency in strong assessment measures and Breckenridge et al. (1999) suggest that this is in part due to the scales’ context (p. 168). Results from various studies suggest that a multi-method approach is most effective when assessing trichotillomania. “An ideal TM measure would include homogeneous subscales that measure situational variables, affective states, and sensory stimuli associated with hair pulling behaviour in addition to frequency, duration, and interference of symptoms” (Breckenridge et al., 1999, p. 168). To date, trichotillomania lacks answers to such questions as whether the disorder is conceptually related to OCD or more similar to other disorders such as skin picking (Penzel, 2000, p. 1). The controversy with respect to etiology has an extensive impact on assessment methods and tools. Inevitably, assessment influences treatment and treatment affects outcome, so this begs the question: are trichotillomaniacs obtaining appropriate benefits from current methods?

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Extreme Stress in the First Trimester Associated with Schizophrenia

There already exists much evidence of low birth weights and pre-maturity among newborns of mothers that suffer stressful life events during pregnancy. "Chemicals released by the mother’s brain in response to stress may have an effect on the fetus’ developing brain. These effects may be strongest in early pregnancy, when protective barriers between the mother and fetus are not fully constructed."

Schizophrenia is believed to commence during early brain development; however environmental factors during a pregnancy may influence the risk of developing schizophrenia.

A study conducted by Ali S. Khashan of the University of Manchester suggests a likelihood of developing schizophrenia when a child’s mother experiences a stressful event during the first trimester of pregnancy.

The subjects in this study consisted of 1.38 million Danish births occurring between 1973 and 1995. A national registry was used to verify relatives of the mothers that either passed away or received a diagnosis of cancer, heart attack or stroke during the course of their pregnancy. Khashan found that during their pregnancies, the mothers of 21,987 children were exposed to the death of a relative, mothers of 14, 206 children were exposed to a relative receiving a diagnosis of cancer, heart attack or stroke, and most striking, 7,331 children observed had eventually developed schizophrenia.

Results illustrated a 67% greater risk of developing schizophrenia or other disorders when exposed to the death of a relative during the first trimester. Six months prior to pregnancy or any other time during the pregnancy held no significance in the development of schizophrenia. As well, the significance appeared only in those without a family history of mental illness.

Although, the study only assesses risk and is not suggesting any concrete findings, it would have been more informative to have knowledge the schizophrenics’ age at the end of the study in order to rule out any possible association with societal changes or social upheavals. Also, research on a more global perspective would certainly have supported the validity of the study. Overall however, this does provide a decent starting point for future research.

Article

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Naps Facilitate Learning

The period of non-REM sleep essentially consists of the other four sleep stages and lasts between 90 and 120 minutes, while each individual stage lasts anywhere from 5 to 15 minutes in length.

A recent study by Matthew A. Tucker, PhD, of the Center for Sleep and cognition and the department of psychiatry at Harvard Medical School, has discovered that a short 45 minute non-REM nap during the afternoon can have important benefits for an individual’s declarative memory performance.

Declarative memory consists of accessible conscious memory, such as semantic memory which refers to factual knowledge and episodic memory which refers to theoretical knowledge.

The study demonstrated that compared to those with equivalent periods of wakefulness, a nap facilitated declarative memory performance for all who mastered the memory tasks during training.

"These results suggest that there is a threshold acquisition level that has to be obtained for sleep to optimally process the memory," said Dr. Tucker. The study suggests that a nap can help one to retain well-learned material.

Ironically, the study made no suggestions regarding sleep habits facilitating the acquiring of new information.

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