Minggu, 14 Oktober 2012
What Doesn't Kill You Makes You Stronger
I wanted to share this with you -- I thought you might find Act 3 interesting. It's about a woman with life-threatening OCD. Act 3 starts just after the 36 minute point and lasts for about 15 minutes.
Sabtu, 13 Oktober 2012
What Does Vitamin B12 Do and What are Signs of B12 Deficiency and How Treated
What Does Vitamin B12 Do Where Do You Get B12 and How is B12 Deficiency Treated?
Depression,Thinking and Memory Problems with B12 Deficiency
What are common nerve symptoms of B12 deficiency?
B12 deficiency can include tingling, weakness, numbness, problems walking or thinking, depression or memory problems.
Can't you just get all the vitamins you need from food?
Don't we make all the vitamins we need? The answer may be no and no. Vitamin B12 is essential for the body to create dna and is needed for neurological processes. B12 has a key role in the normal functioning of the brain and nervous system, and for the formation of blood. It is one of the eight B vitamins. It is normally involved in the metabolism of every cell of the human body, especially affecting DNA synthesis and regulation, but also fatty acid synthesis and energy production. Neither fungi, plants or animals are capable of producing vitamin B12.
Can't We Make B12 ?
Risk factors for vitamin B12 deficiency include older people, alcohol abuse, diabetics who take metformin, vegetarians,people with gastritis, crohn's disease,certain gastric bypasses,etc.
Since your body can't manufacture B12 you need to get it from someplace else by taking a vitamin or eating something that contains it.Vitamin B12 can be given as a shot and or taken as an oral vitamin. People especially older people and vegetarians may not be able to get enough vitamin B12 from their diet and may need B12 vitamin supplementation.
The acid in the digestive system helps get the B12 out of meat that we eat. That is one reason that people who have certain gastritis or malabsorption have problems getting B12. People who use the drug metformin, a diabetes drug, need to be screened for B12 deficiency.
Kamis, 11 Oktober 2012
How Intense Should Blood Sugar Control Be in Type 2 Diabetes
How Intense Should Blood Sugar Control be in Type 2 Diabetes and How Do Doctors Measure Blood Sugar Control in Diabetes?
A Study Published in 2011 Said That While Blood Sugar Control is Very Important Very Intensive Glycemic (Blood Sugar) Control did not seem to Reduce Mortality Beyond a Shadow of A Doubt and was Associated with Severe Low Blood Sugar
Control of blood sugar in people with diabetes is very important.The American Diabetic Association “Standards of Medical Care in Diabetes” recommends lowering HbA1c to <7.
Doctors know that people with diabetes must work to keep their blood sugars normal and that high blood sugars are associated with eye, heart, kidney and circulation and foot problems. The billion dollar question is how low should sugars be?
Doctors searched the medical literature for studies of the benefits of very tight control of blood sugar. The idea is if tight control of blood sugars is known to be beneficial than maybe very tight control of blood sugar is even better. The doctors tried to combine the results of 14 studies with a technique called meta-analysis.
In this Large Meta-Analysis Intensive Glycemic Control Did Not Reduce Mortality and was Associated with an increased Risk of Severe Hypoglycemia
Their meta-analysis did not demonstrate beyond a shadow of a doubt that super intense control of blood sugars had these extra benefits and they did find evidence of dangerous low blood sugar (hypoglycemia).
"We found evidence to refute the suggestion that intensive compared with conventional glycaemic control reduces all cause mortality with a relative risk reduction of 10% or more. We found insufficient information to confirm or exclude a 10% relative risk reduction in cardiovascular mortality and non-fatal myocardial infarction with intensive glycaemic control. We found insufficient evidence for a reduction in risk of composite microvascular complications, retinopathy, and nephropathy. Conversely, we confirmed a 30% increase in relative risk of severe hypoglycaemia with intensive compared with conventional glycaemic control. Accordingly, treatment and choice of a glycaemic target for patients with type 2 diabetes need to take both harms and benefits into account."
Rabu, 10 Oktober 2012
Falling: Faces of Depression and Anxiety (by Clara Lieu)
Clara Lieu is an artist at Rhode Island School of Design.
She has this amazing gift of observation. For example, she has this series on her website (claralieu.com) called Waiting. Here is how she describes it.
I am interested in the contradictions found in waiting figures: even though these figures stand in very close physical proximity to each other, it seems apparent that there is a significant emotional distance between them. Each figure seems locked within their own existence, unaware and unresponsive to the other figures surrounding them. Yet simultaneously, waiting in a line creates a situation where the gesture of one figure leads directly to the next, creating a fluidity between all of the figures. I am engaged by the individual and group anxiety that seems to permeate such silent and still scenes.
She also completed a very impressive series of drawings and sculptures called Falling. This series, unlike her others, are very personal, based on her own experience with depression.
She emailed My Three Shrinks to let us know about her work. I was so impressed that I asked her more about herself and the motivation to show such an intimate view of her anguish.
I developed depression and anxiety at a young age, and lived with the condition for most of my life before being diagnosed and treated just a few years ago. It was startling to see myself clearly for the first time, free from the disease. Only at that point did I have the emotional distance that allowed me to to be in position to address this subject artistically. I knew at that point that I felt an uncontrollable drive and compulsion to make the work.
"Falling" was an unusual project me for in that it was told from a very personal, intimate perspective unlike my previous projects, which approached the subject matter with an emotional distance. Depression is something that happens privately, behind closed doors; it's a secret that most people keep hidden and never talk about in public. Unfortunately here's still a social stigma associated with depression that causes people with depression to conceal their true emotions from others. On a broader level, I'm looking to open a dialogue about a topic that is rarely discussed openly by exposing my own personal experience.
She goes on to describe this body of work:
"Falling" is a visualization of personal experience with depression and anxiety. The condition brought on frequent episodes where I felt emotionally and physically out of control. Unable to “release” myself from these episodes, I waited for the physical limitations of my body to end them. Recounting the affected years, I realize how accustomed I became to depression’s influence; many emotions and feelings belonged to it and not my own personality. After an extended, untreated struggle, a diagnosis brought relief, and the process of unearthing myself from the disease began.
Her work can be found at claralieu.com.
Note: October 11 is National Depression Screening Day. Get screened.
People Lose More Weight in Commercial Weight Loss Program
British Study Says People Lose More Weight in a Commercial Weight Loss Program like Weight Watchers, Rosemary Conley or Slimming World than by Counseling from their Doctors
File this in the stuff I didn't need a study to figure out department. A study that appeared in a British medical journal reported that people who joined a commercial weight loss program were more successful at losing weight than people who just got counseling from a doctor.
In the study several hundreds of over weight people in England were recruited into a study to see if people lost more weight when they got counseling from a primary care provider or if they joined a commercial weight loss group. The weight control groups were commercial weight loss programs in Great Britain such as Weight Watchers, Rosemary Conley or Slimming World. The primary care counselors were a doctor counseling someone on weight loss or pharmacy one to one counseling or a group from the British National Health Service called Size Down..
They looked at weight loss at 12 weeks and at one year. The most effective weight loss was in people who had participated in a commercial weight loss program. The least effective was someone who had just got counseling from a doctor.
Selasa, 09 Oktober 2012
Dinah is Mad
A few days ago, I posted a link to what I thought was a nice article in the New York Times about a special team of NYC police officers who talk people out of jumping off bridges and buildings, and even jump into the waters to fish them out. The responses to the post and to my comments left me a bit distraught. It's been a while since Shrink Rap has been this contentious, and it left me feeling rather defensive. I tried to put up a response in the comment section, but my comment was too long, so I'm posting it as it's own post.
First, Sarebear, thank you. She wrote:
"The range of human behavior, motivations, reactions to illnesses is huge. Just because it's not YOUR experience, doesn't mean it isn't valid as someone else's. Just because your experience isn't THEIR experience, doesn't make yours invalid either."
Brilliant. Thank you.
To the assortment of anons who felt inspired to write in with:
"Yet again, I wonder if this is how you interact with your patients. How do you maintain a practice? Or do you perhaps see only the very mildly mentally ill, the slightly neurotic." and " It's also surprising that both of you claim enough knowledge of suicide to present at a conference."
I think you should find other another psychiatry blog. This is far beyond the realm of what one would say to someone in their living room, and the readiness with which you insult us is as though we are not human beings with feelings! I showed this to my husband whose response was "I don't know why you do this and why you would interact with people this way."
My comment on the damage suicide leaves in it's wake is a statement of fact. One friend told me that she started to feel just a little better five years after her son's suicide.
A reader responded that my comment was "demeaning and insulting." " Of course every suicidal person has considered carefully, long and hard, the effect his or her suicide will have on his loved ones. The implication that they have never thought such a thing is really offensive."
To the anon who wrote:
"Dinah, it sounds like you've never treated suicidal people. If true, it is surprising."
I have never treated a patient who has successfully committed suicide. I have treated two patients who have had serious attempts while under my care, and many who have had serious attempt before they were my patient. In general, a serious suicide attempt is reason change doctors -- it is a sign that the treatment is not working, and it destroys trust.
And while I have not treated many seriously suicidal patients, most people with depression have suicidal thoughts and feelings, different from what it takes to complete the actual act. On the rare days when the thoughts seem like anything more than thoughts, I have no qualms about telling my distressed patient that I would be devastated if they committed suicide.
I can't count the number of people I have treated who have had relatives commit suicide, but it's a lot. Should we start with the woman whose husband waited until she was coming up the walk to shoot himself in front of her? That began her long and involved time as a psychiatric patient.
No, it's not always thought out enough to be "selfish," (I never used that word) sometimes it's from psychosis, sometimes it's a teenager who can think of no other way to deal with heartbreak, sometimes it's an escape, other times it is the by-product of overwhelming depression. It's still leaves generations of pain.
Over 38,354 died by suicide in 2010, despite the best efforts of psychiatry, the NYPD jumper team, and the lack of mental health euthanasia teams. That number doesn't count the suicides done in ways that medical examiner might have deemed accidental.
Jane, we don't believe that people with intractable psychiatric problems should kill themselves, much less have an institution promoting euthanasia for the mentally ill (what's next?). We believe they should change doctors, try different or unconventional therapies, seek other opinions from experts, and we see psychiatric conditions as treatable.
Re: The suicide prevention conference: they invited us to present, we had never heard about the conference before.
I am sorry to be so defensive. The comments from this post left me very angry.
I will leave you with a quote from the comment section of the NYTimes article on their Special Teams:
Casey from Denver wrote:
This work is profoundly important because many people thinking of suicide change their mind. A study by Dr. Richard Seiden of people prevented from jumping from the Golden Gate Bridge found that after an average of 26 years, 94% were still alive or died of natural causes. One of the rare jumpers who survived said later:
“The last thing I saw leave the bridge was my hands. It was at that time that I realized what a stupid thing I was doing . . . It was incredible how quickly I had decided that I wanted to live.” So keep up the good work, you brave men and women of the Emergency Service Unit!
First, Sarebear, thank you. She wrote:
"The range of human behavior, motivations, reactions to illnesses is huge. Just because it's not YOUR experience, doesn't mean it isn't valid as someone else's. Just because your experience isn't THEIR experience, doesn't make yours invalid either."
Brilliant. Thank you.
To the assortment of anons who felt inspired to write in with:
"Yet again, I wonder if this is how you interact with your patients. How do you maintain a practice? Or do you perhaps see only the very mildly mentally ill, the slightly neurotic." and " It's also surprising that both of you claim enough knowledge of suicide to present at a conference."
I think you should find other another psychiatry blog. This is far beyond the realm of what one would say to someone in their living room, and the readiness with which you insult us is as though we are not human beings with feelings! I showed this to my husband whose response was "I don't know why you do this and why you would interact with people this way."
My comment on the damage suicide leaves in it's wake is a statement of fact. One friend told me that she started to feel just a little better five years after her son's suicide.
A reader responded that my comment was "demeaning and insulting." " Of course every suicidal person has considered carefully, long and hard, the effect his or her suicide will have on his loved ones. The implication that they have never thought such a thing is really offensive."
To the anon who wrote:
"Dinah, it sounds like you've never treated suicidal people. If true, it is surprising."
I have never treated a patient who has successfully committed suicide. I have treated two patients who have had serious attempts while under my care, and many who have had serious attempt before they were my patient. In general, a serious suicide attempt is reason change doctors -- it is a sign that the treatment is not working, and it destroys trust.
And while I have not treated many seriously suicidal patients, most people with depression have suicidal thoughts and feelings, different from what it takes to complete the actual act. On the rare days when the thoughts seem like anything more than thoughts, I have no qualms about telling my distressed patient that I would be devastated if they committed suicide.
I can't count the number of people I have treated who have had relatives commit suicide, but it's a lot. Should we start with the woman whose husband waited until she was coming up the walk to shoot himself in front of her? That began her long and involved time as a psychiatric patient.
No, it's not always thought out enough to be "selfish," (I never used that word) sometimes it's from psychosis, sometimes it's a teenager who can think of no other way to deal with heartbreak, sometimes it's an escape, other times it is the by-product of overwhelming depression. It's still leaves generations of pain.
Over 38,354 died by suicide in 2010, despite the best efforts of psychiatry, the NYPD jumper team, and the lack of mental health euthanasia teams. That number doesn't count the suicides done in ways that medical examiner might have deemed accidental.
Jane, we don't believe that people with intractable psychiatric problems should kill themselves, much less have an institution promoting euthanasia for the mentally ill (what's next?). We believe they should change doctors, try different or unconventional therapies, seek other opinions from experts, and we see psychiatric conditions as treatable.
Re: The suicide prevention conference: they invited us to present, we had never heard about the conference before.
I am sorry to be so defensive. The comments from this post left me very angry.
I will leave you with a quote from the comment section of the NYTimes article on their Special Teams:
Casey from Denver wrote:
This work is profoundly important because many people thinking of suicide change their mind. A study by Dr. Richard Seiden of people prevented from jumping from the Golden Gate Bridge found that after an average of 26 years, 94% were still alive or died of natural causes. One of the rare jumpers who survived said later:
“The last thing I saw leave the bridge was my hands. It was at that time that I realized what a stupid thing I was doing . . . It was incredible how quickly I had decided that I wanted to live.” So keep up the good work, you brave men and women of the Emergency Service Unit!
Senin, 08 Oktober 2012
Reading While Depressed
In the current issue of the Paris Review, a reader writes in asking what she should read while depressed. Review writer Sadie Stein answers with a number of interesting suggestions, followed by 67 reader comments with additional ideas.
If you need to clean your head out from our last post and discussion, read this:
Life-Affirming Reads
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