Tag 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

 

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.

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.

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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.

On a Personal Note

Why does every depressed person who poses for a picture assume some variation of this pose?

My move from veterinary clinical practice to public health practice wasn’t just a matter of changing a job. Working in clinics, I felt that working there was a danger to my well-being. Not so much my physical well-being, though I did get my share of bites and scratches, and when I was still working with large animals a well-placed kick could have landed me in the hospital. I’m speaking of our mental health, our sanity–our souls, if you will.

We may bring our own problems with us wherever we go, but environment, including career choice, may play a role as well. In other words, I was probably at least partially correct. It turns out that vets are 4 times more likely than the general population to commit suicide, and twice as likely as those in other health professions.

The news came out earlier this year in an article in the Veterinary Record, a British peer-reviewed veterinary journal. The article is titled Veterinary surgeons and suicide: a structured review of possible influences on increased risk. (Veterinarians are called veterinary surgeons in the UK).

Here’s the abstract:

Veterinary surgeons are known to be at a higher risk of suicide compared with the general population. There has been much speculation regarding possible mechanisms underlying the increased suicide risk in the profession, but little empirical research. A computerised search of published literature on the suicide risk and influences on suicide among veterinarians, with comparison to the risk and influences in other occupational groups and in the general population, was used to develop a structured review. Veterinary surgeons have a proportional mortality ratio (PMR) for suicide approximately four times that of the general population and around twice that of other healthcare professions. A complex interaction of possible mechanisms may occur across the course of a veterinary career to increase the risk of suicide. Possible factors include the characteristics of individuals entering the profession, negative effects during undergraduate training, work-related stressors, ready access to and knowledge of means, stigma associated with mental illness, professional and social isolation, and alcohol or drug misuse (mainly prescription drugs to which the profession has ready access). Contextual effects such as attitudes to death and euthanasia, formed through the profession’s routine involvement with euthanasia of companion animals and slaughter of farm animals, and suicide ‘contagion’ due to direct or indirect exposure to suicide of peers within this small profession are other possible influences.

From 1999-2006 “intentional self-harm,” known to the rest of us as suicide, was  the 11th major cause of death in the United States. (It ranks much higher among the young, especially in the 15-24 year age category.) In high-income countries, the 3rd major cause of disease is depression. People struggling to survive in low-income countries, in spite of being at increased risk for other causes of disease, still carry a burden of depressive disorders that cause  them  to rank 7th overall as in causes of illness. However, you look at it, one’s own brain is capable of ruining or taking the life of the organism that supports it. This is not weakness, or a lack of character, any more than cancer is the moral fault of a person’s immune system to fail and recognize a danger created from within.

Laughter always helps