Category Archives: Mental Health

Mental Health Monday, either early or late

From Nursing Mental Diseases, by Harriet Bailey, RN

MS. BAILEY WROTE IN 1929:

In the prevention of mental deficiency segregation is recognized as a most important measure, for these individuals have not the mental qualities which make them valuable to society, and economically they are a partial or a total loss. Furthermore, it is an established fact that this type of defective family increases at about double the rate of the general population, that feeblemindedness is inherited, for parents cannot transmit to their children nervous and mental strength which is not theirs to give. From some recent studies made of the feebleminded, it has been shown that not all mental defectives are a social menace, and therefore in need of segregation. Thees studies have also shown that when properly educated and specially trained in the manual and industrial arts, many of them become quiet, law-abiding, useful citizens. Experience also shows that only through education and supervision may they be saved from lived of inefficiency, failure, dependency, and misery.

feebleminded table

 

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From the Army’s deck of “Freedom Cards”

During the Iraq and Afghanistan wars,  US Army issued a deck of playing cards with various messages on them.

suicide  6 of clubsFreedom cards suicide warnings

Veterinary Medicine Once Again Profession with Highest Suicide Rate in UK

High-risk occupations for suicide.
Psychol Med. October 2012;0(0):1-10.
S E Roberts1; B Jaremin; K Lloyd
1College of Medicine, Swansea University, Swansea, UK.

Article Abstract

BACKGROUND: High occupational suicide rates are often linked to easy occupational access to a method of suicide. This study aimed to compare suicide rates across all occupations in Britain, how they have changed over the past 30 years, and how they may vary by occupational socio-economic group.

METHODS: We used national occupational mortality statistics, census-based occupational populations and death inquiry files (for the years 1979-1980, 1982-1983 and 2001-2005). The main outcome measures were suicide rates per 100 000 population, percentage changes over time in suicide rates, standardized mortality ratios (SMRs) and proportional mortality ratios (PMRs).

RESULTS: Several occupations with the highest suicide rates (per 100 000 population) during 1979-1980 and 1982-1983, including veterinarians (ranked first), pharmacists (fourth), dentists (sixth), doctors (tenth) and farmers (thirteenth), have easy occupational access to a method of suicide (pharmaceuticals or guns). By 2001-2005, there had been large significant reductions in suicide rates for each of these occupations, so that none ranked in the top 30 occupations. Occupations with significant increases over time in suicide rates were all manual occupations whereas occupations with suicide rates that decreased were mainly professional or non-manual. Variation in suicide rates that was explained by socio-economic group almost doubled over time from 11.4% in 1979-1980 and 1982-1983 to 20.7% in 2001-2005.

CONCLUSIONS: Socio-economic forces now seem to be a major determinant of high occupational suicide rates in Britain. As the increases in suicide rates among manual occupations occurred during a period of economic prosperity, carefully targeted suicide prevention initiatives could be beneficial.

Our never-ending wars and PTSD

SOMETHING TO CONTEMPLATE WHILE WE ARE WRITING THE NEXT POST

Who do you think would have a higher incidence of Post-Traumatic Stress Disorder, the regular active-duty full time soldier, or the reservist, who spends most of his time with family and career, and then gets sent of to war?

What about the civilian/soldier who got drafted, back in the days when we had a draft ?(The draft ended in 1973, when we ended our military involvement in Vietnam.)

How long has this problem been studied?

Mental Health Mañana: The Sports-fueled Psyche and the Suicide Squeeze

APPARENTLY, THERE IS QUITE A LOT OF CRYING IN BASEBALL. But is there less than there is in real life?

It's only a game, dammit.

Although many parents may feel like putting themselves out of their own misery while watching what seems like the 49th inning of the 57th Little League game of the month, there are at least a handful of researchers out there who think that playing sports is good for the mental health of those young folk out on the field. In The Journal of Pediatric Behavior and Development, Lindsay Babiss and James Gangwisch published an article entitled Sports participation as a protective factor against depression and suicidal ideation in Adolescents as mediated by Self-Esteem and Social Support. In this article, the authors take it as a given–from other studies, albeit–that sports are protective against depression and suicidal ideation, and then go on to determine what aspects of sports participation  actually mediate the improved mental health.

(Apparently, the neither of the authors ever walked in the last run, missed the winning shot, or accidentally scored a goal against his or her own team.)

In the end, the authors conclude that sports participation is protective against depression and suicidal ideation, and that middle school and high school aged children should be encouraged to engage in sports.They draw this conclusion based on their results: that for at least a small percentage of  adolescents–about 12%–that sports participation is at least a part of what kept them from plunging into the depths of despair, or from thinking about jumping from bridge.

Do the results merit this conclusion? In other words, it possible that this is correlation and not causation? Exercise, seemingly more than anything else in the past ten years, has been touted as a panacea. Google the terms “exercise and depression” and you will find no end of articles , from the tabloids to the scholarly journals, stating that a good run is  great medicine. Its benefits range from serving as a mildly beneficial  therapeutic adjunct to being that magic bullet that treats many ills, including  and especially, depression.

But are the authors engaging in that most of common of epidemiological mistakes, confusing correlation with causation? Certainly, with suicide being among the top 5 causes of adolescent death, this is no trivial matter. I am sure that there are a lot of parents that would care greatly whether or not the slavish devotion our society has to youth sports will actually make life better (whatever that means) for their children. I ask these questions for two reasons: 1) as a parent, I am concerned for my children’s happiness, and 2) at least on recent article has cast doubt on the whole exercise-depression question. It seems, at least to one group of researchers, that exercise doesn’t help depression, but that less depressed people exercise more. There is, of course, no doubt that it’s better to be a fit depressive than an unfit one, but let’s not ascribe more benefits to exercise than it really has.

“Whenever I feel like exercise I lie down until the feeling passes.”
–Robert Maynard Hutchins

Mental Health Mittwoch: Is Ketamine Going to Revolutionize the Treatment of Depression?

Ketamine is well-known to veterinarians. It is hard to imagine a veterinary drug cabinet without it. Developed originally in 1962 as a battlefield anesthetic for wounded soldiers, it was quickly adopted by veterinarians for use in their patients, and unlike many anesthetic agents, whose day comes and goes, ketamine has been part of the  basic tool kit for veterinarians for the entire time.

It has also moved beyond it’s original use as a balm for injured soldiers, and is found in all hospitals .  Indications for use  in humans include (from Wikipedia):

  • Pediatric anesthesia (as the sole anesthetic for minor procedures or as an induction agent followed by muscle relaxant and endotracheal intubation)
  • Asthmatics or patients with chronic obstructive airway disease
  • As part of a cream, gel, or liquid for topical application for nerve pain—the most common mixture is 10% ketoprofen, 5% Lidocaine, and 10% ketamine. Other ingredients found useful by pain specialists and their patients as well as the compounding pharmacists who make the topical mixtures include amitriptyline, cyclobenzaprine, clonidine, tramadol, and mepivicaine and other longer-acting local anaesthetics.
  • In emergency medicine in entrapped patients suffering severe trauma
  • Emergency surgery in field conditions in war zones
  • To supplement spinal / epidural anesthesia / analgesia utilizing low doses

THE KETAMINE EXPERIENCE

Using ketamine in a clinic, a new veterinarian learns quickly that at as a sole agent, ketamine is not very good. The animals tend to become rigid during their sedation, their eyes remain open, and they don’t exhibit the floppy type of sedation that we prefer when working with a sedated or anesthetized animal. Furthermore, recoveries from ketamine look rather bizarre and uncomfortable, with the animal swinging his head back and forth as if he’s watching a marathon game of tennis.  Therefore, when used in a veterinary clinic, ketamine is virtually always combined with another drug, generally one that provides relaxation. A historically common ‘cocktail’ is s 50:50 volume mixture of ketamine and valium.

This looks like a cat on ketamine.Note the unrelaxed posture and the open eyes.

Humans, likewise, report hallucinations when using the drug as a sole agent, and physicians will often combine it with other drugs to minimize this effect. The hallucinogenic potential  has made ketamine a popular ‘club’ drug, like MDMA (Ecstasy) or Rohypnol. Until 1999, Ketamine was unscheduled, meaning that it wasn’t a controlled substance. We could use the drug without having to log every single dose used, and without fear of scrutiny from the FDA. Alas, because of ketamine’s growing popularity as a recreational drug, the Feds moved and made ketamine a controlled substance.

.

I’m not quite sure how this was discovered, but ketamine has a rapid and profound effect on depression. Unlike Prozac and the other selective serotonin reuptake inhibitors (SSRIs) which usually take 3-6 weeks to “kick-in”, ketamine takes effect within 24 hours, and often within 2 or 3 hours of administration.

And here is the strange part. Although ketamine’s half-life  is only 3  hours, the anti-depressive effect seems to last at least a week. (A half life is the time it takes for half of the substance to be cleared, so, for example after 4 half-lives [1/2->1/4->1/8->]1/16th of the substance will remain.)

THE FUTURE OF DEPRESSION THERAPY?

So, imagine this. You are in the midst of a depressive episode. Instead of taking a several week regimen of pills, you go to the doctor’s office in the morning, and by lunchtime you are feeling like yourself again.

Fortunately, instead of burying this because of fears of abuse, studies are going forward. The National Institute of Mental Health is conducting clinical trials of the effect of ketamine on major depression and bipolar disorder. The Department of Defense is collaborating with Mt. Sinai School of Medicine on a clinical trial testing ketamine as a rapid treatment for Post-Traumatic Stress Disorder.

There are doctors who are already using ketamine to treat depression. At UCSD, the psych department  offers treatment-resistant depressives intravenous ketamine as a treatment. Because it is not an approved use of ketamine, insurance will not cover it. Ketamine is not an expensive drug. Perhaps in the future depressives will be able to dose themselves with intramuscular shots, much the same as diabetics treat themselves with insulin.

Mental Health Mittwoch: Another reader responds on veterinary suicide

 

From The Book of Bunny Suicides: Little Fluffy Rabbits Who Just Don't Want to Live Any More , by Andy Riley, Plume 2003. Published here without permission but available from The Seminary Co-op Bookstore

From a reader in the UK:

Hi – I too left a lovely job in academia teaching at a vet school in Canada partly due to environmental pressures – we had regular suicides either among postgraduate students or colleagues, the latest a former colleague of mine I’d worked closely with – I’ve been touched by suicide already several – too many! – times, the latest now in our community since we live in the UK….I stumbled across your blog in doing some research on the figures in our profession in the UK, as I would like to get involved in the wider community to raise awareness of this taboo subject…I’ve also since reinvented myself to get away from the terrible work pressures of this profession, having ditched practising as a vet a long time ago when warning bells sounded in my head – I simply realised I wasn’t up to handling the stress. I tip my hat to the many colleagues that do. I’m glad to have read your blog about it.

PS: New post on The Meta-Bug.

Mental Health Monday (because it’s Monday somewhere.)

(No, actually, it’s not. You’re just late.)

you can leave out the Knives and nooses, at least until new year’s.

North Pole Coroner, Ülf Bjøngerøgekkøn, ruled out foul play, saying that the Good Saint's death was a suicide.

Right about now the usual talk about the holidays and depression starts to circulate, and we take it as axiomatic that some people are going to spiral into a family/excess expense/sugarplum-fueled vortex of despair. But, wait, there’s good news! In the category of things-you-won’t-believe-but-are-nonetheless-true, falls the myth about suicide and Christmas.

THE DATA

Researchers Simon Carley and Mark Hamilton reviewed 16 papers on the Christmas-New Year’s season (Emerg Med J 2004 21: 716-717), and found that suicide and parasuicide rates go down around Christmas. They do, however, rise slightly at the start of the New Year.

Despondent? Celebrate with those you love, and don’t go home alone.

Mental Health Monday

From a paper by John Cacioppo, PhD:

Social isolation is typically defined in the epidemiological
literature in terms of a few simple indexes
such as marital status, contact with a close friend,
religious member, and member of voluntary groups.
The literature on the hypothesized human need to
belong, in contrast, has emphasized the psychological
impact of social interactions and relationships rather
than their presence or absence (eg, 5). Although a
measure of marital status, contact with family and
friends, church membership, and/or membership in
voluntary groups may correlate with feelings of social
isolation, the correlation is imperfect for several reasons.
Time spent alone can foster restoration or constructive
efforts rather than feelings of isolation, for
instance, and conflicts with marital partners and
friends can create feelings of loneliness as well as
elevations in autonomic function and stress hormones
over extended periods (6). Even church membership,
an index of social integration, can produce feelings of
conflict and isolation (7).

(Think about this before you head to midnight mass. )

Zappa, Winter and Vitamin D, Part 2

(Click here for part 1)

The British Medical Journal does not give free online access, therefore I have reprinted a letter regarding the foolishness of putting our clocks back an hour in the fall, thus giving less daylight when we most need it. (The use of bold is from this blog, not the author of the letter.)  I have always dreaded the approach of the “fall back” weekend. The extra hour of sleep seems little recompense for the late afternoon gloom that descends upon us that weekend.

One of my few good childhood memories of the Nixon Administration was when RMN decided to go back to Daylight Savings Time– it was the middle of winter, and the change was enacted as a energy-saving response to an energy crisis. Yes, we left for the school bus in the dark, but oh, what wonderful compensation in that hour of afternoon light!

It's light out! Let's party!

More daylight, better health: why we shouldn’t be putting the clocks back this weekend

  1. Mayer Hillman, senior fellow emeritus, Policy Studies Institute, University of Westminster, London

Lack of exercise is a major public health problem in the United Kingdom, contributing to the incidence of chronic illness. Adults are recommended to engage in at least 30 minutes of moderate or vigorous activity daily and children at least an hour. However, surveys have shown a trend towards declining fitness, on the basis of which it has been predicted that more than half the population will be clinically obese by 2050.

Health experts have proposed urgent action to remedy this situation, and the government now aims to get far more of the inactive population walking or gardening regularly or, preferably, taking up more vigorous physical activity, such as sports, aerobics, or cycling (especially as a means of travel). Although most people are aware of the benefits—a lessened risk of coronary heart disease, obesity, diabetes, hypertension, and some cancers—routine physical activity features in few people’s everyday lives. Only a small proportion of adults are motivated to undertake it throughout the year, and the school curriculum allocates insufficient time for it. In addition to removing the social, economic, and psychological barriers to activity, the measure seen to be most effective is providing more public facilities and open spaces—and networks of safe walking and cycling routes to reach them—that are sufficiently local that the journeys to get to them are not so long that the actual activity is curtailed.

Research has shown that people are happier, more energetic, and less likely to be sick in the longer and brighter days of summer, whereas their mood tends to decline—and anxious and depressive states to intensify—during the shorter and duller days of winter. People have a greater sense of wellbeing in daylight and overwhelmingly prefer it to artificial light. The common reaction to the prospect of less daylight and sunlight when the clocks are put back at the end of October, signalling as it does the end of outdoor activity and the onset of a largely indoor leisure life, is a negative one.