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Mental Health Feature

Post-Traumatic Stress Disorder: Screening is the First Step

Posted: November 2019

We all probably know someone that has seen combat in war, has been victimized, or has been subjected to or witnessed some other traumatic experience. After such an experience, the mind and body are in shock. As people make sense of what happened and process their emotions, they start to move through the shock. For some though, they continue to relive the events over and over. These people have Post-traumatic Stress Disorder (PTSD) and remain in psychological shock.

Typically, PTSD symptoms will start within a month of the traumatic event; but for some, the symptoms can manifest years later. People with PTSD tend to experience nightmares or flashbacks and may avoid places or things that remind them of the traumatic experience. They also tend to be hyper-vigilant.

Statistics estimate that 7-8 (up to as many as 13) people out of 100 will experience PTSD at some point in their life. It is estimated that 50% of people with PTSD will never reach out for professional help.

While several different types of medications are used to treat PTSD, antidepressants are the most studied. They can help with worry, anger, sadness, and feelings of numbness. Other medications may be used to help with sleep disturbances. Psychotherapy, including Exposure Therapy and Cognitive Restructuring, is another type of PTSD treatment. Getting patients into psychotherapy so they can talk about what happened is important for their overall recovery. In addition, each person should be encouraged to do things on their own to achieve the best possible treatment outcome.

As providers, we need to recognize the changes in our established patients, especially if we know of a recent traumatic experience in their life. Don’t be afraid to ask questions about and screen for PTSD symptoms. The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) is a 5-item screen that was designed for use in primary care settings and can identify individuals with probable PTSD. The sooner that the signs of PTSD are recognized, the better the outcome for the patient.

References:

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Beyond the PHQ9: Being Resource Ready

Posted: October 2019

According to the Anxiety and Depression Association of America, Major Depressive Disorder affects more than 16.1 million American adults. That’s approximately 6.7% of the U.S. population age 18 and older in a given year.

In primary care and many other practice settings, certified PAs periodically utilize the Patient Health Questionnaire-9, (PHQ9) or other depression screening tools as part of periodic assessment for depression. When these questionnaires are positive, certified PAs have an opportunity to manage the disease along multiple fronts. It starts with being prepared.

Medical management options for depression are plentiful; however, treatment modalities span far beyond prescription medications. These include lifestyle changes, support groups, cognitive behavioral therapy, psychiatry/psychology consultations, and inpatient/residential treatment.

Have you considered recommending lifestyle changes or therapy for your patients? Are you familiar with the mental health community resources, practitioners, and facilities in your area? To get started, become resource ready using the suggestions below. Take your preparations a step further! Develop your own informational handout to share with patients.

References:

https://adaa.org/about-adaa/press-room/facts-statistics

Resources:

SMI Adviser:  A Clinical Support System for Serious Mental Illness includes additional resources for clinicians and providers as well as individuals and families. 

 


Suicide Prevention: Conversation to Save a Life

Posted: September 2019

1.4 million - that’s the estimated number of suicide attempts in 2017. As the 10th leading cause of death in the United States, there is drastic room for improvement in suicide prevention and in the mental healthcare system, and we must become proactive about having difficult conversations.

What can you do as a medical provider, colleague, friend, or family member? Knowledge and compassion are crucial when it comes to preventing suicide. Know the warning signs for risk of suicide and ACT – talk to those that you believe may be at risk. This can be an awkward conversation, but here are six easy steps from the American Foundation for Suicide Prevention:

1. Talk to them in private.
2. Listen to their story.
3. Tell them you care about them.
4. Ask directly if they are thinking about suicide.
5. Encourage them to seek treatment or to contact their healthcare provider or therapist.
6. Avoid debating the value of life, minimizing their problems, or giving advice.

Then, be prepared if they are contemplating suicide:

1. Take them seriously.
2. Stay with them.
3. Help them remove lethal means.
4. Call the National Suicide Prevention Lifeline 1-800-273-8255.
5. Escort them to mental health services or an emergency room.

Suicide prevention doesn’t have to be hard. As family members, friends, colleagues, and healthcare providers, we need to start conquering these difficult conversations, being honest, and looking out for others. Having this conversation just once can change someone’s life forever.

References:

https://afsp.org/about-suicide/suicide-statistics/

https://afsp.org/find-support/when-someone-is-at-risk/

Resources:

National Suicide Prevention Lifeline:  1-800-273-8255. 

Or, text TALK to 741741 to text with a trained crisis counselor form the Crisis Text Line for free, 24/7”

SAMHSA’s suicide prevention resources, including screening and assessment tools as well as population-specific toolkits, help identify persons at risk for suicide and offer resources to help.

The American Foundation for Suicide Prevention raises awareness, funds science-based research, and assists those affected by suicide. 

 

 

Let’s Talk About It: Help End Stigma Around Mental Illness

Posted: August 2019

Despite scientific advancements in the understanding and treatment of mental illness, there continues to be a stigma associated with mental illness. In fact, the Surgeon General identified stigma as a public health concern.

Stigma stems at least in part from the fact that for hundreds of years, mental illness was perceived as something bad, like the mark of the devil or a type of moral punishment. Unfortunately, individuals with mental illness were ostracized and isolated; and most treatments were inhumane.

While we know more about mental illness today and can more effectively manage it with treatments and medications, people still tend to shy away from mental illness like it is taboo. Stigma also contributes to patients not seeking treatment that would improve their quality of life.

As providers, we can help change society’s perceptions about mental illness as well as an individual’s perceptions about their illness. We can help them understand they have an illness that can be treated and remind them that they are not alone. Encourage your patients to connect with organizations like the National Alliance on Mental Illness (NAMI).

Plus, as providers, we should be doing all that we can to debunk the stigma of mental illness by educating those around us. We can use respectful language to talk about mental illness, recognize the connection between mental and physical health, challenge misperceptions when we see them, and encourage all to see individuals rather than their condition.

References:

https://www.verywellmind.com/mental-illness-and-stigma-2337677

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489832/

https://www.nami.org/blogs/nami-blog/october-2017/9-ways-to-fight-mental-health-stigma

U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999. 

Resources:

Social media: Follow the #EndStigma hashtag and connect with others seeking to change perceptions about mental health.

 

 

 


Low Testosterone and its Effect on Mood and Behavior

Posted: June 2019

June is upon us and with that we often associate the warmer and sunnier days, outdoor activities, and “summer fun” with an improved mood. Unfortunately, these changes do not bring a better mood for all.

As we celebrate Men’s Health Month, it seems appropriate to take note of an often-missed contributor to mental health issues in the male population – specifically how low testosterone can impact mood and anxiety.

Low testosterone is a clinical condition that can be caused by chronic illnesses, medications, or can simply be part of the natural aging process. Regardless, symptoms can impact more than just libido – men may experience mood swings, depression, fatigue, and anxiety. Sometimes when men present with mood symptoms or problems with anxiety, clinicians are quick to treat with antidepressants or other psychiatric medications. This may not adequately address the problem, and men may be left with unresolved symptoms that are affecting their everyday lives.

While low testosterone is not the only possible differential diagnosis for mental health symptoms, it is one that should not be missed. This month let’s all make a special effort to consider the whole person with symptoms of depression or anxiety and rule out the physiologic possibilities before prescribing.

References:

Bain, J. The Many Faces of Testosterone, Clinical Interventions in Aging. 2007 Dec; 2(4): 567-576. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686330/

Resources:

 

 

 


Taking Care of Baby … and Mom: Maternal Mental Health in the "Fourth Trimester"

Posted: May 2019

As we settle into the spring season and enjoy a time of new beginnings, growth and restoration, may it also be a reminder to bringing awareness to our mental health and self-care.  

May is Mental Health Awareness month; and the internet and social media have covered thousands of stories from different women who have experienced post-partum depression. This brings awareness and hope to new moms everywhere because you too are not alone! 

According to the CDC, post-partum depression and anxiety are common disorders that affect 1 in 7 women, but only a small number of women will seek treatment. You do not have to have a history of depression to experience post-partum depression or anxiety.  Symptoms can appear any time during pregnancy and the first 12 months after childbirth.  Symptoms may include feeling sadness, guilt, irritability, inadequacy, or difficulty connecting with your baby; and these symptoms can range in severity.

Regardless of clinical presentation, every woman should be assessed for depression in the post-partum period. Women are encouraged to speak to your certified PA or another healthcare provider about exactly how you are feeling. There are effective research-based treatment options available to help women recover.  

If at any point you have thoughts of harming yourself or baby, please call 911 or 1-800-SUICIDE to receive immediate care.  Here are a few resources for women in the perinatal and post-partum period to help guide you with more support through this journey. 

References:

https://www.cdc.gov/reproductivehealth/depression/index.htm

https://www.nimh.nih.gov/health/publications/postpartum-depression-facts/index.shtml

https://www.psychcongress.com/article/counseling-interventions-can-prevent-perinatal-depression

Resources:

1. My Wish for Women:  A social cause initiative to reduce the stigma of postpartum depression and anxiety

2. Social Media: Knowing you are not alone is very important to healing through this process.  Use #mywishformoms on Instagram to find women from all over the world who are telling their stories.

3. Postpartum Support International: Includes great patient and provider resources