Cognitive Therapy Aids Childhood Anxiety
October 31, 2008
A new research study finds that cognitive behavioral therapy (CBT) can be an effective modality for treatment of childhood anxiety disorders.
Researchers found treatment that combines CBT with an antidepressant medication is most likely to help children with anxiety disorders, but each of the treatments alone is also effective.
“Anxiety disorders are among the most common mental disorders affecting children and adolescents. Untreated anxiety can undermine a child’s success in school, jeopardize his or her relationships with family, and inhibit social functioning,” said NIMH Director Thomas R. Insel, M.D.
“This study provides strong evidence and reassurance to parents that a well-designed, two-pronged treatment approach is the gold standard, while a single line of treatment is still effective.”
The Child/Adolescent Anxiety Multimodal Study (CAMS) randomly assigned 488 children ages 7 years to 17 years to one of four treatment options for a 12-week period:
Cognitive behavioral therapy (CBT), a specific type of therapy that, for this study, taught children about anxiety and helped them face and master their fears by guiding them through structured tasks;
The antidepressant sertraline (Zoloft), a selective serotonin reuptake inhibitor (SSRI);
CBT combined with sertraline;
pill placebo (sugar pill).
The children, recruited from six regionally dispersed sites throughout the United States, all had moderate to severe separation anxiety disorder, generalized anxiety disorder or social phobia. Many also had coexisting disorders, including other anxiety disorders, attention deficit hyperactivity disorder, and behavior problems.
John Walkup, M.D., of Johns Hopkins Medical Institutions, and colleagues found that among those in combination treatment, 81 percent improved. Sixty percent in the CBT-only group improved, and 55 percent in the sertraline-only group improved.
Among those on placebo, 24 percent improved. A second phase of the study will monitor the children for an additional six months.
“CAMS clearly showed that combination treatment is the most effective for these children. But sertraline alone or CBT alone showed a good response rate as well. This suggests that clinicians and families have three good options to consider for young people with anxiety disorders, depending on treatment availability and costs,” said Walkup.
Results also showed that the treatments were safe. Children taking sertraline alone showed no more side effects than the children taking the placebo and few children discontinued the trial due to side effects. In addition, no child attempted suicide, a rare side effect sometimes associated with antidepressant medications in children.
CAMS findings echo previous studies in which sertraline and other SSRIs were found to be effective in treating childhood anxiety disorder. The study’s results also add more evidence that high-quality CBT, with or without medication, can effectively treat anxiety disorders in children, according to the researchers.
“Further analyses of the CAMS data may help us predict who is most likely to respond to which treatment, and develop more personalized treatment approaches for children with anxiety disorders,” concluded Philip C. Kendall, Ph.D., of Temple University, a senior investigator of the study.
“But in the meantime, we can be assured that we already have good treatments at our disposal.”
The study was funded by the National Institutes of Health’s National Institute of Mental Health (NIMH) and puiblished online in the New England Journal of Medicine.
Source: NIH/NIMH
One In Five Hospital Admissions Are For Patients With Mental Disorders, USA
October 31, 2008
Bipolar Disorder Involves A Lower Quality Of Both Mental And Physical Life, Even In Periods Of Normality
October 31, 2008
Charles nemeroff : vns : cyberonics and emory: senator grassley has work to do
October 31, 2008
During A Response-Imaging Task, MRI Brain Activity In First-Episode Bipolar Mania
October 30, 2008
Both Mental And Physical Quality Of Life Affected By Bipolar Disorder
October 29, 2008
BPN 51: Manic
October 29, 2008
Quality of Life With Bipolar Disorder
October 29, 2008
New research evaluates the quality of life of patients suffering from bipolar disorder (BD) in comparison with the general population.
In the study, University of Granada scientists analyzed 108 patients with bipolar disorder against a comparative group made up of 1,210 persons from a general population sample.
Inside the group of patients, 48 of them were euthymic, this is, without active symptoms of the disease; the remaining 60 patients (non-euthymic) presented relevant symptoms during the evaluation.
Bipolar disorder, known in the past as manic-depressive disorder, affects approximately 3 of every 100 persons and consists of suffering recurrent depression episodes (depressive phases) alternating with periods of euphoria (manic phases). The patients swing intensely (usually in weeks or months) from happiness to sadness, besides enjoying periods of normality (euthymia).
Scientists discovered patients with BD present worse mental health than the general population; in addition, they found bipolar patients have a poorer quality of life at a physical level.
This could be due to a higher consumption of addictive substances such as alcohol and tobacco, the long-term secondary effects of the pharmacological treatment and a more sedentary way of life.
The research also suggests that people with bipolar disorder who suffer a lower quality of mental life are those who started to suffer the disease before 20 years old, who have been suffering it for a longer time, who suffer the II subtype of the disease, who are dependent on tobacco and who are suffering depressive symptoms at present.
However, Granada researchers found that having a high social support (such as that of the family) is connected with a better quality of life for the patient.
Furthermore, their work has made clear that depressive symptoms (sadness, listlessness, tiredness, concentration difficulty, insomnia, poor appetite, etc.) have a higher impact in the quality of life than maniac symptoms (excessive self-esteem, lack on inhibition, verbosity, hyperactivity, increase of sexual appetite, etc.).
Depressive symptoms also produce more disability or negative repercussions for work, family and social life; this observation reflects the fact that maniac symptoms are usually shorter in time and have a good response to medication, whereas depressive ones are usually more difficult to eliminate.
In conclusion, lead researcher Luis Gutiérrez Rojas insists that there should be a more active intervention to help those people who present depressive symptoms or a high tobacco dependence.
However, other variables which could seem less relevant a priori, such as having a family history of the disease, having suffered many episodes of the disorder or having carried out suicide attempt, are not variables significantly connected with a bad quality of life.
Source: Universidad de Granada
Two Per Cent Of People In England In Contact With NHS Specialist Mental Health Services, New Report Shows
October 29, 2008
Can I Have My Manic Loved One Hospitalized?
October 29, 2008
Many friends and family members of people with bipolar disorder become frustrated with the fact that they can rarely, if ever, “make” their loved one obtain treatment. This is more of a challenge when the person is manic rather than depressed. In a manic episode, your loved one is more likely to think that you’re the problem. They are neurologically incapable of having the “insight” to realize that anything they’re saying or doing is out of the ordinary. In fact, they might feel better than ever – on the top of the world!
Fortunately, current laws lean toward protecting the rights of everyone to make decisions for themselves. This is fortunate, because nobody wants to create a police state in which one person can have another institutionalized just by accusing the person of being irrational. (People with bipolar disorder are just as intelligent, oftentimes more so, than others and have every right to get into heated discussions when they disagree with someone, without having the threat of a forced commitment hanging over them.)
It’s unfortunate, however, when, as in the case of bipolar mania, the person’s brain is incapable of realizing that something’s wrong, and destructive (and self-destructive) behaviors are allowed to continue unchecked – emptying bank accounts, destroying relationships, and placing the health and well being of the individual and others at risk.
Hospitalizing a person against their wishes is a very sensitive issue, and I don’t want to come across as though I am “taking sides” here. Nobody really knows what it’s like from either person’s perspective until you’ve been there. It’s difficult for everyone involved. In many cases, however, patients who have been hospitalized against their wishes look back and are thankful for the care they received. Very often, a brief stay in the hospital helps reboot the brain, stabilize moods, and give everyone some pause to catch their breath.
By law, the official line is that only medical or mental health professionals can evaluate a person and mandate that the person stay in a hospital or mental health facility… and only on the condition that they “deem the person to be a danger to themselves or others.” The word “danger” is generally interpreted in terms of physical danger. If the professional thinks that the individual in question is likely to harm himself or herself physically, is suicidal, is physically threatening, or is out of control to the point of causing a serious accident (driving too fast, playing with fire, etc.), they’re obliged to have the person admitted to a hospital or mental healthcare facility, with or without the permission of the person or their friends or family members.
Until a medical or mental health professional deems the person “a danger,” the person remains free to be verbally abusive, to overspend or gamble away the family savings, to be sexually promiscuous, and so forth. They can even be psychotic as long as the psychosis does not create dangerous behavior. Of course, family and friends are likely to interpret such behaviors as the person posing “a danger to themselves and others,” but by law, professionals and the courts must analyze it differently.
So, the question is, what can you do as a friend or relative when your loved one is in the throes of a manic episode and really does need to be hospitalized? Here are some suggestions:
- Call your loved one’s doctor or therapist and report what’s going on. Due to privacy issues, the doctor or therapist can’t give you any information, but there’s no law preventing them from listening to what you have to say.
- If your loved one is obviously talking and behaving irrationally, offer to drive them to their doctor’s office or hospital for something to calm them down. The doctor’s evaluation could lead to a mandatory hospitalization. But be careful – driving with an irrational person in the car can be a risky endeavor.
- Call the police or dial 911 and ask for help. (We provide some specifics on what to say later in this post.)
- Contact your local mental health “crisis team” if one exists. These are mobile teams that will come to you to assess your loved one for safety and the need for care. Be sure that you have the phone number for the team posted several places in your home. You may want to contact the team when there isn’t an emergency to give all the basic information so that in a crisis all of the basic paperwork has already been done. If your loved one is willing to meet with the team before an emergency situation occurs, all the better.
If you cannot access a specialized mental health crisis team, then the police will be the first responders, but they will be unlikely to show up if you simply report that you think you’re loved one is experiencing a manic episode and you’re worried about them. Be specific:
- Report a “violent EDP” or “suicidal EDP.” EDP stands for emotionally disturbed person.
- Describe exactly what your loved one did or said to make you think the person is a danger to himself or others. Did he or she threaten suicide? Did your loved one threaten you or someone else? Is the person driving erratically?
- When the police show up, make a solid case for why you believe your loved one is a potential danger to himself or others. If others have witnessed the incidents, have them back you up. Point out any damage your loved one may have caused. The police don’t want to take your loved one to the ER for an evaluation, so you have to give them good reason.
- Be clear that your loved one has been diagnosed with a mental illness. You want the police to be aware that this is not just someone behaving badly or someone who is intoxicated. Use the term “mental illness” in everything you tell them.
I’m not recommending that you do this, but some people have reported turning over furniture before the police arrive to stage a violent scene. When the police witness the chaos, they’re a little more likely to conclude that your loved one really is in a violent state. Again be careful – police departments vary dramatically in their mental health savvy and level of training for working with those in a mental health crisis. You want to avoid a dangerous confrontation between your loved one and the officers as this could cause another set of problems.
If the mental health emergency team or police take your loved one to a hospital, be sure to follow up with the healthcare team to make sure your friend or relative has everything they need – perhaps most importantly, their medications. Bringing clothes, pajamas, and other “comforts of home” can also help make your loved one’s stay more comfortable, but call the facility beforehand to find out what’s allowed and what’s not.
