Mental Health Matters

Transcription

1 Mental Health Matters Vol. 20, No. 3, September 2006 Formerly News Digest Dear Reader, The Commonwealth of Virginia continues its attempt to partner with the private sector, although the private sector has not been asked whether it is a willing partner. Efforts are continuing to transfer the treatment of mentally ill patients from state hospitals to the community hospitals. The Commonwealth s ultimate goal is full diversion, in which private hospitals undertake the care of most chronically ill and acute care mental health inpatients. There are several inherent problems with the Commonwealth s plan. The first is economics. The Commonwealth pays private hospitals less than what Medicaid pays, and everyone knows that Medicaid doesn t cover our costs to deliver care. Furthermore, there isn t enough bed capacity in the private community to handle all of these patients. Simple laws of economics say in order to increase capacity, the service provider must receive adequate reimbursement. The Commonwealth must pay a reasonable amount for its plan to work. William Semones Continued CONTINUED ON on PAGE page 22 Handling the transition from high school to college By Frank Selden, Ph.D., Clinical Psychologist, Bridges Treatment Center The transition from high school to college entails many changes and is often stressful for both students and parents. Students are facing significant changes in their lives, with a new sense of autonomy and freedom to make their own choices. Parents may feel their guidance and ability to help their child develop into better decision makers are diminished. They may have concerns about the student s living situation, activities away from home, safety and personal well-being. The stressed freshman Most high school graduates experience anticipatory anxiety during their senior year or over the summer prior to college. This is especially true for students who are going away to school. Leaving home for the first time means more than packing belongings to settle in a new environment. There are multiple factors that affect firstyear college students, including: Separation. High school graduation means students are separating from familiar activities, such as their participation in school sports, clubs and community organizations. More importantly, they are leaving their high school friends and family for a situation where they don t know what to expect. The notion of an extended support structure can be fairly challenging, particularly if the student does not know anyone at the college. It is important that students recognize how friendships are developed and to CONTINUED ON PAGE 4 Frank Selden, Ph.D., is a child and adolescent psychologist with Centra Health s Piedmont Psychiatric Center and Bridges Treatment Center. Dr. Selden Dr. Selden earned his bachelor s degree from the University of Virginia and his master s degree in education and doctorate from the University of Georgia. He completed a predoctoral internship in clinical psychology at the Oklahoma State Department of Health Consortium. Mental Health Services

2 Dear Reader continued from page 1 Negotiations are under way in our region, but the executive directors have refused to meet directly with the private providers. Another problem with full diversion is that our hospital is set up as an acute care facility, with an average length of stay of six or seven days. Programmatically, we are not set up to meet the needs of chronically ill mental health patients in an acute care environment. These patients are the sickest of the sick and need to be hospitalized in a program that will meet their clinical needs. A third issue is that full diversion is at odds with the mission of a community hospital. Hospitals in the private sector are set up to take care of the citizens in their communities. Why should the citizens of central Virginia subsidize the cost of caring for patients across the Commonwealth? There may come a time when full diversion will work. Currently, however, there is a lack of communication, an uneven playing field and not a true partnership between the Commonwealth and private hospitals. Until these fundamental aspects are corrected, the path to full diversion can only be adversarial. To your health, William W. Semones Vice President Psychotic symptoms, disorders and differential diagnosis By Michael E. Judd, M.D., Adult Psychiatrist, Piedmont Psychiatric Center, and Gary Sibcy II, Ph.D., Licensed Clinical Psychologist, Marriage and Family Therapist, Piedmont Psychiatric Center Editor s Note: This is the second in a series about severe mental disorders. There are three primary types of psychotic symptoms: hallucinations, delusions and thought disorders. (Hallucinations were discussed in the previous issue of Mental Health Matters.) Delusions Delusions are another way in which psychosis may be manifested. Delusions are firmly held false beliefs. They may be characterized as bizarre (not plausible) or non-bizarre. Common delusions involve themes of paranoia, grandiosity, jealousy or somatic concerns. Examples of bizarre versus non-bizarre delusions include a patient reporting a federal agency is after him and has removed all of his internal organs, versus a patient reporting his belief that his wife is having an affair with his boss (not necessarily likely, but possible). Disturbed thought processes Thought disorders may be separated into disturbances of process or content. Disordered thought content has been discussed above and includes hallucinations and delusions. Disturbed thought processes involve a disruption in the form of thinking. For example, individuals may exhibit any number of problems in relaying information. They may exhibit racing thoughts, loosening of associations (talking about ideas that do not really connect together), flight Dr. Judd Michael E. Judd, M.D., is a board-certified adult psychiatrist and medical director of Centra Health s Piedmont Psychiatric Center. Dr. Judd received bachelor s degrees in biology and psychology from St. John Fisher College, and his medical degree from Ross University School of Medicine. He trained in psychiatry at the University of Virginia s Roanoke/Salem Psychiatric Medicine Residency Program. Gary Sibcy, Ph.D., is a clinical psychologist, a licensed marriage and family therapist and a licensed professional counselor with s Piedmont Dr. Sibcy Psychiatric Center. He holds a doctorate in clinical psychology from The Union Institute and University in Cincinnati, Ohio, and a bachelor s of science degree in psychology and a master s in counseling from Liberty University. CONTINUED ON NEXT PAGE 2

3 of ideas, tangentially (never really answering a question, going down bunny-trails and never coming back to the point) or circumstantiality (giving so much detail about something that they cannot get to the point), thought blocking, thought broadcasting, neologisms (making up their own words), or clang associations (saying words because they rhyme, I took the train, bang, fang, hang, tame ), all of which impair the way in which individuals communicate their thoughts to others. Psychotic symptoms and different diagnosis The differential diagnosis of psychotic symptoms may be divided into: mood or affective disorders (depression with psychotic features, schizoaffective disorder or bipolar disorder), brief psychotic reaction, schizophreniform disorder, schizophrenia, delusional disorders or organic etiologies. Psychotic symptoms and mood dysregulation Individuals with mood disorders may exhibit psychotic symptoms at various times during the course of their illness. Patients with severe major depressive disorder may present with, or develop, psychotic symptoms (usually AH) at any time. The key to making this diagnosis is the presence of psychotic symptoms only when severe depression is present. The treatment focuses on controlling the depression (treating to remission) with antidepressants and short-term use of atypical antipsychotic agents. Schizoaffective disorder is a type of mood disorder characterized by mood symptoms, as well as psychotic symptoms; however, the psychotic symptoms are present in the absence of mood symptoms (during periods of euthymia). Patients who are bipolar spend approximately twothirds of the time with some type of affective dysregulation. Depressive episodes are much more frequent than manic episodes. In these individuals, psychotic symptoms are typically seen during the height of a manic episode. Treatment of schizoaffective disorder usually involves an antidepressant and/or a mood stabilizer. Treatment of bipolar disorder includes the use of a mood stabilizer (which may be an atypical antipsychotic agent) that may also be cautiously combined with an antidepressant. Schizophrenia A comprehensive discussion of schizophrenia is beyond the scope of this article; however, some details need to be addressed. Schizophrenia is a complex and chronic illness often characterized by medication noncompliance and frequent relapses. The five types of schizophrenia are: paranoid, catatonic, disorganized, undifferentiated and residual. 3 Key issues related to making this diagnosis include the presence of psychotic symptoms for at least 30 days and a decreased level of functioning for at least six months. Primary treatment includes atypical antipsychotic medications, social support and case management. Other psychotic disorders A brief psychotic disorder is characterized by the sudden onset of a positive psychotic symptom (delusion, hallucination, disorganized speech or behavior) that occurs rapidly and is present one to 30 days, then resolves completely. This disorder is typically seen in high functioning individuals who are in extremely stressful situations. Treatment involves managing the stress and the shortterm use of atypical antipsychotic agents. Schizophreniform disorder is similar to schizophrenia, with the exception that comparable symptoms are present for one to six months, and a decline in function is not necessary to make the diagnosis. Treatment involves antipsychotic agents. A delusional disorder is characterized by the presence of one or more non-bizarre delusions. Olfactory or tactile hallucinations may be present and related to the delusional theme (i.e., an individual believes a rat follows her around, and she believes, on occasion, she smells the rat). Auditory and visual hallucinations may be present, but not prominent. Patients with a delusional disorder generally do not have a significant impairment in social and occupational functioning. Delusional disorders are extremely difficult to treat, but antipsychotic agents may prove helpful. Organic cause of psychotic symptoms is most common The broadest category responsible for psychotic symptoms is organic. This category includes, but is not limited to: substance use, medications, delirium, neoplasms and nutritional deficiencies. This category exemplifies the importance of obtaining a complete and comprehensive history. Any concerns regarding the patient s medications or health considerations should be referred to the patient s primary care physician or psychiatrist for further evaluation and treatment. Substance abuse issues should be discussed with the patient, and then the patient should be referred for treatment. To be continued in the next issue of Mental Health Matters. * This article was published originally in Christian Counseling Today, 2005, Vol. 13, No. 2.

4 College continued from page 1 choose friends wisely. That being said, and the internet have made it considerably easier for friends to stay in touch with each other long after they leave high school. Independence. Newfound freedoms and a different environment are exciting, but also frightening. Students who feel sad and lonely may choose to use this independence in unhealthy ways, experimenting with abusive substances that can mask their sense of displacement from home and friends. Organization. The organization of daily life at college setting up a dorm room, scheduling classes, shopping, laundry may be entirely new to students living on their own for the first time. Some students may be prepared to meet this challenge; others may not. Parents can help A foundation of open and honest communication between parent and child will help immensely when it is time for the transition to college. By discussing issues of responsibility, finances, time management, social activities and study skills, parents can continue to influence the choices a student makes, both academically and socially. Scheduling routine communication through phone calls, and visits will help assuage concerns throughout the college years. One of the most important actions parents can take initially is to understand and relate the needs of their child to the size of the colleges and universities under consideration. Some high school graduates are prepared to make the leap to a university; others may be better served by a smaller college. At larger schools, students are more anonymous and may feel less connected to instructors and other students. Smaller schools allow for more of a sense of community among students and the potential of more attention from faculty members. Other students may feel more comfortable attending a community college close to home before leaving to study at a four-year college. Parents should ask themselves if their child can be successful in a learning environment in which classes are taught in amphitheaters over television monitors or would the student be better served in smaller classes taught by instructors who can answer questions directly. The location of the college or university also may be critical to a student s success. Many schools are located in communities with their own environmental stressors, such as high crime rates or a nightlife that offers opportunities for students to stray from healthy lifestyles. In addition, parental anxiety will be diminished if they feel as comfortable with the community as they do with the college. Counseling centers The stress of transitioning to college can often lead to emotional or psychological issues or cause a relapse of problems associated with mental health conditions. Parents and students should address any mental health concerns prior to attending college, discuss anticipated stresses with their mental health provider and develop a plan should symptoms recur or intensify. 4 Students face significant changes in their lives as they begin their college careers. Some are better prepared than others. Every college and university offers counseling services at an oncampus counseling center or through a network of professional mental health providers. It is particularly advantageous to have on-site providers who understand the campus community. Students and parents should familiarize themselves with available counseling resources. Most students come under pressure in one form or another during the college years, and counseling centers are set up to provide short-term counseling or crisis assistance when needed.

5 Despite the myths, most retirees fare well The average lifespan of Americans has increased dramatically during the past century, from 47 years in 1900 to more than 75 years in the mid 1990s, with a significant number of people aged 85 or older. As post World War II baby boomers enter their 60s, this trend is expected to continue well into the future. Improved diet, physical fitness and health care means that more adults are reaching age 65, most often thought of as the age of retirement, in better physical and mental health than in years past, according to Mental Health: A Report of the Surgeon General. And despite negative myths and stereotypes frequently associated with retirement, recent research shows that most people fare well in this phase of their lives. During retirement, people have a chance to explore new interests and activities, form new relationships and renew old friendships. Retirees are more likely to have lower stress levels and to engage in regular exercise. A study of retirees and non-retirees published in the Journals of Gerontology showed there were no differences between the groups on self-reported mental health status, coping, depression, smoking, alcohol consumption and frequency of drunkenness, leading the authors to underscore the importance of assessing positive benefits associated with retirement. A recent model by Robert Kahn, M.D., and John Rowe, M.D., suggests that successful aging is contingent on three elements: avoiding disease and disability, sustaining high cognitive and physical function and engaging with life. Drs. Kahn This phase of our lives has been most rewarding and has added so much more enjoyment in living than we ever thought possible. and Rowe say these three major elements must act in concert because none is deemed sufficient by itself for successful aging. Current research has enabled mental health and general health care providers to suggest strategies and skills to help retirees find enjoyment and satisfaction at this stage of their lives. The growing number of retirement communities nationwide attests to these theories that promote wellness for aging Americans. The greatest benefit in retirement communities is the community itself, said Janna Bradley, marketing director of The Summit, a continuing care retirement community in Lynchburg. People live with 5 Celia and Norvel Vandegrift Residents of The Summit peers who have had similar life experiences. Planned activities, meals, housekeeping, security and around-the-clock assistance remove the stress from their lives. Summit residents Celia and Norvel Vandegrift couldn t agree more. Mrs. Vandegrift, who worked at the Central Virginia Training Center for 38 years, retiring as assistant director, and her husband, who worked for the Virginia Highway Department, retired to their family s farm in Brookneal in They had looked forward to retirement, and enjoyed growing and harvesting hay and raising cattle, guineas, peacocks and rabbits. CONTINUED ON THE BACK

6 Retirement continued from page 5 We thought we would always be there, said Mrs. Vandegrift. Then my husband s health began to fail. An abdominal aneurism, hip replacement and chronic obstructive pulmonary disorder landed Vandegrift in a powered chair and breathing from an oxygen tank 24 hours a day. It left Mrs. Vandegrift alone to do the farm chores, depending on friends and family for help. Facing the reality that they could not stay at their beloved farm, the Vandegrifts began considering alternatives. At The Summit, they found former friends they hadn t seen in years and the realization that they were entering the next phase of life. Not that it was easy. Bradley, The Summit s marketing director, says that the greatest toll on most people is the idea of giving up their home, both emotionally and physically, and the Vandegrifts were no exception. There were so many family ties and history to our farm, Glendale, Mrs. Vandegrift said. I felt close to my parents and family heritage there, and it was so much of who I am and who I was, that saying goodbye to it was heart wrenching. Once they knew they were moving to The Summit, the next step was taking the time and emotional energy to rummage through all the memorabilia that had been collecting dust over the last 55 years of our marriage, she said. How does one handle stepping back in time and realizing it is time to let go? But after tears, laughter, yard sales and trips to Goodwill, the Vandegrifts moved to The Summit. Mrs. Vandegrift said, Burdens began to drift away. No more dayto-day burdens of yard upkeep, grocery shopping and planning meals. We quickly learned that retirement living is the life for us. The Vandegrifts have found this new phase of their lives to be so good that Norvel s health has improved immeasurably. Thanks to his thrice-weekly exercise at the Jamerson Family YMCA, he is walking without assistance and requires oxygen only half of the time. Friends and family think he has found the Fountain of Youth. Bradley said such improvements are not uncommon at retirement communities. As many seniors become isolated, they do not eat well-balanced meals, they lose contact with the outside and they lack intellectual stimulation, she said. In a retirement community, they become more engaged in their own lives as well as in the community itself. Satisfaction surveys at retirement communities nationwide indicate residents are happy, she said. People go about their lives with a lot more enthusiasm than they do in their own homes. Mrs. Vandegrift said, Instead of coping from one day to the next, we look forward to new things and have as much excitement as we want. This phase of our lives has been most rewarding and has added so much more enjoyment in living than we ever thought possible. If only we had known then what we know now. There would have been fewer tears, less stress and a quicker desire to make this transition earlier in our lives. Mental Health Matters Vol. 20, No. 3 September 2006 Produced by s Mental Health Services and Communications/Marketing Department. For more information about the Mental Health Services division, please call (434) For referrals or admissions, call Mental Health Services, (434) or (800) , 24 hours a day. Mental Health Services Virginia Baptist Hospital 1920 Atherholt Road Lynchburg, VA Return Service Requested Non-Profit U.S. Postage Paid Permit #13 Lynchburg, VA S.548