Showing posts with label therapy. Show all posts
Showing posts with label therapy. Show all posts

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You want to do what?!?! The importance of informed consent in treatment





By Gail  A. Edelsohn, MD, MSPH





We come across ads in print, on television
and on the Internet for medications and therapies that promise to make your child
do his homework without a screaming match, behave better and generally restore
harmony to home life. Not so easy, taking a medication raises a host of
questions:  How long does the therapy
take? Should I as the parent sign off on this? What about the possible serious
side effects, such as significant weight gain, thoughts about suicide, risk of
diabetes or a life-threatening condition?








Parents and legal guardians make
decisions about psychosocial therapy and medication treatment for children and
adolescents every day. But who should give permission and sign informed
consent?  What should parents, advocates,
guardians be looking for or consider before signing informed consent? Is
signing a form enough?  What about the child
or teen - do they have a voice regarding their own treatment?


What is Informed Consent?


Psychiatric informed consent
involves a parent or legal guardian giving
permission for his/her child to undergo evaluation and treatment.  It is a
process which partly involves receiving sufficient relevant information about
the condition, prognosis, risks and benefits of treatment to be given and other
types of treatment available. Informed consent is NOT simply a signed and dated
form. Parents and guardian should expect informed consent to include:




  The purpose of the treatment


  • To address a specific condition or diagnosis?



  • To lessen symptoms?



  •  To change behaviors?


  The effects of treatment


  • How will you know if it is working?



  •  How long till you see an effect?


  Risks of treatment


  • Side effects of medications



  • Consequences of psychosocial treatment (e.g., therapy
    can be emotionally difficult)


  Risks of NO treatment


  • Will symptoms improve over time without
    treatment?



  • Will things get worse or lead to other
    consequences? (e.g., Untreated individuals are more likely to use substances,
    get into legal trouble)


  What alternative treatments are available?
  

For medication


  • Is it FDA approved for this age and condition?
    (i.e., prescribed FDA on label)



  • If it is prescribed off-label, why?



  • Are there any FDA warnings about the medication
    and what do they mean?



  • What is the plan for stopping or phasing out the
    medication?









     Parents and legal guardians are
asked to give legal permission or informed consent for treatment.  If a child is in foster care, it may be the
parent or it may be child welfare service or court that can give consent.   Where a child is living (home, out of home
placement) does not tell you who the legal guardian is.  In some states an adolescent may give
informed consent for psychiatric treatment depending on the state’s legislation
about mental health procedures. Ideally the parents/guardians and the child
should be involved in treatment decision making.



Children also have a voice in
this process.  Children and youth should
be involved in giving assent.  Assent involves providing the child or teen
with information about the therapy or medication in terms appropriate to their
age and stage of development. The assent process should include opportunities
for the child/adolescent to ask questions and have their concerns addressed.






Gail A.
Edelsohn, MD, MSPH, is senior medical officer with Community Care Behavioral
Health, clinical professor of psychiatry and human behavior,  Jefferson
Medical College, and clinical professor of psychiatry and behavioral science,
Temple University School of Medicine.

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What You Should Know About Binge Eating Disorder: 3 Doctors Discuss


By Arshya Vahabzadeh, M.D. Follow @VahabzadehMD



Holly Peek, M.D., MPH Follow @PsychGumbo



Mona Amini, M.D., MBA Follow @MonAmiMD





What Causes Binge Eating Disorder? 




With up to 4 million Americans having binge eating disorder, it's a significant health issue for our nation.  Binge eating disorder has a wide variety of causes, and sometimes it can be caused by several different reasons, even in the same individual.


To understand why someone develops binge eating disorder, we need to recognize binging triggers. These triggers often result in binging behavior, and they are often negative feelings or thoughts toward body shape, weight, or food. Triggers to binging may also include worry, anxiety, difficult relationships with loved ones, or even boredom. Some people binge eat because it helps them numb these feelings in the short term. But later, they find the binge eating to be harmful to their own self-perception.




Sometimes dieting may be a major factor for binge eating. While dieting tends to happen after binge eating disorder has started, missing meals or not eating enough can lead to binging episodes. If left untreated, binging behaviors become more and more ingrained and harder to control.


Depression has also been linked to binge eating disorder. People who have depression or have been depressed in the past are more at risk. Binge eating is also higher in people who have bipolar disorder or anxiety disorder. Some evidence suggests that it may be more common in people who have addictions to recreational drugs.


Binge eating disorder may be more common in families where the condition is already present. Therefore it seems that our genetics are also an important factor to consider. Researchers continue to explore more scientific explanations on why binge eating disorder happens including studying the neurochemicals and pathways of the brain. 


How is Binge Eating Disorder Treated? 





The treatment goal for binge eating disorder focuses on binge eating and weight control. Treatment also addresses conditions that commonly occur with binge eating disorder, including depression, difficulty in work or relationships, and distortions in body image.


Treatment outcomes are generally good with psychological treatment often being more helpful than medication based management, although in some cases both are used. There is evidence that cognitive behavioral therapy (CBT), a type of talk therapy, is successful in treating binge eating disorder. Multiple research studies point to benefits with its use. CBT works by disrupting the “binge-diet cycle” by promoting healthy and structured eating patterns, improving body shape and weight concerns, and encouraging healthy weight-control behaviors.


Another type of talk therapy used in treatment is interpersonal psychotherapy (IPT). IPT helps people express and manage their negative feelings without turning to food to cope. Research shows that 20 sessions of CBT and IPT can provide improvements for more than 70% of people with binge eating disorder.


Reading self-help guides like Overcoming Binge Eating by Christopher Fairburn in combination with therapy sessions can also have substantial benefits.


Medications may also be used to ease binge eating disorder symptoms. Serotonin selective reuptake inhibitors (SSRIs), commonly used for anxiety and depression, have been found effective for reducing some binge eating disorder symptoms as well. SSRIs can help with depression often occurring in people with binge eating disorder. Continued research will examine how other medications, including anti-obesity medication and mood stabilizers, may also treat people suffering from binge eating disorder. 



What Should I Say to My Friend / Family Member Who is Suffering?




It is important to take the approach of talking to your loved one with serious intent. Though some people can overcome eating disorders, seeking professional help usually has more lasting positive results. In seeking the care of a professional, both the patient and his/her family benefit from the information presented by the doctor. The first step to talking to someone you care about who has an eating disorder may feel nearly impossible.



  • Patience is key. Being patient and learning facts about eating disorders will guide you (and your loved one). Due to the complexity of binge-eating disorders, communicating your concerns regarding their eating habits and other behaviors will initiate a cumulative effect.

  • Be prepared for a range of responses. Rejection, denial, anger, and shame are just some of the emotions that your loved one may express when you approach her/him for the first time.

  • Avoid judgment, criticism, and simple solutions to disorder. Instead, you should provide encouragement and compassion regarding their feelings and relationships. Your concern and support may be enough for them to seek professional help but know that this is not guaranteed.

  • Recognize binge eating may be just tip of the iceberg. Understanding that binge eating disorder, or any eating disorder, involves food and weight issues as mere symptoms of a deeper and more complex behavioral problem will help your loved one realize they need to acquire healthier coping tools.

  • Know when to ask for assistance. Don't forget that health professionals can alleviate some of the imminent issues that may need to be treated before full recovery is possible. 












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Make Mental Health Your Priority Every Month

By Felicia Wong, M.D



As the month of May comes to an end, make a promise to yourself that personal mental wellness will remain a daily priority.  Mental Health America has been working for 100 years to promote well-being for all Americans and recently developed a resource called 10 Tools to Live Your Life Well based on extensive scientific evidence.



Each day, we face all sorts of demands and drama which can lead to insomnia, lack of concentration, problems in our relationships, and other mental health issues. 
These "10 Tools" provide proven, healthy ways to cope with stress and boost your overall well-being.  Make a commitment to follow this list and feel more relaxed, fulfilled, and focused long after Mental Heath Month is over. . .  
1) Connect with Others. People who feel connected are happier and healthier--and may even live longer.
2) Stay Positive. People who regularly focus on the positive in their lives are less upset by painful memories.
3) Get Physically Active. Exercise can help relieve insomnia and reduce depression.
4) Help Others. People who consistently help others experience less depression, greater calm, and fewer pains.
5) Get Enough Sleep. Not getting enough rest increases risks of weight gain, accidents, reduced memory, and heart problems.
6) Create Joy and Satisfaction. Positive emotions can boost your ability to bounce back from stress.
7) Eat Well. Eating healthy food and regular meals can increase your energy, lower the risk of developing certain diseases, and influence your mood.
8) Take Care of Your Spirit. People who have strong spiritual lives may be healthier and live longer. Spirituality seems to cut the stress that can contribute to disease.
9) Deal Better with Hard Times. People who can tackle problems or get support in a tough situation tend to feel less depressed.
10) Get Professional Help if You Need It. More than 80 percent of people who are treated for depression improve.
So now you know the tools. . . Today is the perfect time to start incorporating this list into your day-to-day routine.  For more information, go to http://www.liveyourlifewell.org/ . 

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ADHD: Can My Kid Just Outgrow It?

By R. Scott Benson, MD





Won't he just outgrow it? This is the wish of every parent – that a little time, a little more love, or discipline, or happy thoughts will solve what might be a serious problem. And I hear this question often from parents of pre-schoolers who are having behavior problems in pre-K programs or daycare settings.



But we can’t wait. And now there is even more research to support the importance of a careful evaluation and treatment when indicated. This month’s Archives of General Psychiatry reports the results of a long term study of children who were diagnosed with ADHD between the ages of 4 and 6 years old. There was a control group of children without ADHD. As adolescents the children with the early diagnosis of ADHD had higher rates of depression and suicidal thoughts. Fortunately, there were no suicides in this study. Benjamin Lahey, Ph.D., the study director is a professor of health studies and psychiatry at the University of Chicago. He said the study “reinforces our belief that parents of young children with ADHD should pay close attention to their child’s behavior and its consequences and seek treatment to prevent possible long-term problems.”



So the better question is “What treatment is recommended for pre-schoolers?” And we have good science to help answer that question. Carefully managed studies have shown that pre-school children and their families should have at least 12 weeks of behavior management training as a first level of care. And this is not just any behavior management. At a conference in Florida, Dr. Regina Bussing recommended that families should consider a number of behavior training programs – the Positive Parenting Program, The Incredible Years, and Parent Child Interaction Therapy. These are intense programs that are very different from a few words of advice from a well-meaning pediatrician or the do-it-yourself manuals that are so prevalent in the bookstores.



Let us know of other successful behavior training programs in your community, and we will post those links here.

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Adult ADHD? Not just a diagnosis for kids

By Felicia Wong, M.D.



There have been several posts addressing ADHD in children on our blog, but did you know that ADHD can affect adults as well? An interesting article in the Wall Street Journal discusses adult attention-deficit/hyperactivity (ADHD) disorder, a condition that may affect up to 10 million Americans, only 4.4 percent of whom know it.




According to government data, an estimated eight percent of U.S. children have ADHD, and some 50 percent outgrow it. But what happens to those who don’t?





It was only in 1980 that therapists began to recognize that ADHD could persist in adults, and even now, getting an accurate diagnosis is tricky. It is controversial topic that has people taking sides. Some experts think that too many adults (and children) are being medicated for ADHD, often by doctors who have little knowledge or experience with this disorder. Others argue that those adults who have experienced functional impairment could benefit from ADHD medications and behavioral therapy.





Some adults whose ADHD is left untreated can encounter negative consequences including high incidence of substance abuse, automobile accidents, difficulty staying employed and maintaining relationships. Yet, adults with ADHD can also be highly intelligent, energetic, charismatic and creative. Those with ADHD may have the ability to focus intently on a narrow range of topics that interest them.





Many adults with ADHD have developed skills to compensate for their distractibility. Some excel in school at an early age, and don’t run into any problems until college/ grad school or starting at a challenging new job. Suddenly, their coping mechanisms are not as effective anymore.



An excerpt from the Wall Street Journal article:



We see people from all of the professions who have managed to succeed despite the limitations,  but they have often done it at significant cost," says Dr. Solanto. "They don't have time to enjoy life. They don't get their work done in the course of a day. They have to stay late after hours, or they are doing without sleep, frantically trying to meet deadlines. It ultimately takes a toll on their wellbeing and a toll on the people around them.




Adult ADHD is tricky to diagnosis and deciding whether to get help for it can be difficult as well. The symptoms that traditionally describe ADHD: restlessness, impatience, procrastination, chronic lateness, and difficulty getting organized, focusing, and finishing tasks are common in busy adults. But how can one tell if it’s just stress, or too much caffeine that is causing their symptoms? What about the stigma and perceptions associated with ADHD? What does it mean to suddenly discover at the age of 40, that you have ADHD?





The key word in determining whether an evaluation should be considered is impairment. As Dr. Jaksa from the article puts it, "Everyone gets distracted. Who's not late occasionally? But if you are chronically late, you lose your job and maybe your friends as well."





Experts say that those who suspect they have ADHD should have a thorough evaluation, with a psychologist or psychiatrist who specializes in the disorder, looking at how they functioned in early childhood, in school and social settings and personal relationships. Once ADHD is diagnosed, most experts recommend treatment with both medication and behavioral therapy.





Here are some adult ADHD key points:





• Adult ADHD can be comorbid with bipolar disorder, anxiety, and depression, further complicating diagnosis and treatment.





• For adults diagnosed with the condition, treatment can consist of behavioral therapy, medication, or both.





• People who think they may have ADHD should be evaluated by a psychiatrist who understands the disorder.





A recent study published in the August 25 issue of the Journal of the American Medical Association, cognitive behavioral therapy (CBT), "a form of psychotherapy that focuses on changing patterns of thought and behavior that are counterproductive, can help" adults with ADHD. For more information on that study and recent news about Adult ADHD – please visit the following links:





Los Angeles Times (8/24, Healy)





CNN (8/24, Landau)





HealthDay (8/24, Gardner)





Reuters (8/25, Pittman)





WebMD (8/24, Hendrick)





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What do the holidays mean to you? It’s how you frame the question.



R. Scott Benson, M.D.



Thanksgiving seems to be the one time a year we can get a national focus on family and sharing with others. And before we finish that pumpkin pie everyone seems to start working on the next holiday which comes in different names in different cultures, but typically involves gifts. In the Santa tradition the focus is on what will he bring me.



But then we realize that is not the real meaning of the holidays.





A tool from cognitive therapy might help at this point, reframing. Reframing involves recognizing distorted thinking and focusing on other thoughts that reflect the reality that we want.



Let’s try an example. Typically we ask children “what do you want?” and later we ask “what did you get?” And these are the questions that define the meaning of the holiday season for them.



I don’t think that is the meaning we intended. So we can try a different approach. And it takes a lot of practice. In working with children or in my community I try to start the conversation with “What have you been thinking about doing for your mother during the holidays?” Or “What do you think your brother would like this year?”



And after the presents have been opened I ask, “Who really liked the present you gave?” And always in this era of instance messaging and Tweeting it never hurts to ask “Have you started on your thank you notes yet?”



Well? Have you?
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