Therapy

I have never had any type of mental issue until randomly about a week ago. I am a very mellow person and have not been dealing with much stress or any other problems and up until now I have been completely normal. All of a sudden last Tuesday my life has drastically changed mentally. All of a sudden I became extremely dazed and light headed to the point where I feel like nothing is real. I thought this was from sleep deprivation or a feeling that would pass but days later it hasn’t gone away. For some reason I am just constantly questioning my existence and what’s been going on and its freaking me out. Basically its as if nothing feels real. I want so desperately for this feeling to go away and I don’t know what to do. I’m not sure if its anxiety and if I need to go to the doctor or what but any advice would help thanks! A. You may be experiencing derealization or depersonalization. Derealization is often associated with anxiety. People who experience derealization say they feel as though the external world is unreal. Depersonalization is also associated with anxiety disorders. People who experience derealization describe feeling as though they’re living in an “unreality” or that they are disconnected from their own feelings. You also mentioned sleep problems. It’s possible that your symptoms are associated with sleep deprivation, depending on how much sleep you have lost. However, you stated that even after catching up on sleep these odd feelings remain. Drug use is also associated with derealization and depersonalization. Marijuana in particular is often associated with the aforementioned symptoms. You did not mention any drug use but it may have been omitted from your letter. The fact that you continue to experience these symptoms suggests that intervention is necessary. Your symptoms may be due to anxiety and if that is in fact the case, your anxiety requires treatment. Meet with a mental health professional and report your symptoms. A mental health professional will collect a full psychosocial history and determine the best treatment for your symptoms. Medication might also be helpful in elevating your symptoms. Please take care. Dr. Kristina Randle Mental Health & Criminal Justice Blog

Good afternoon, I am 21 years old youngest of three. My mother had two children before she met my dad. Then she fell in love with my dad then I came along. I come from a very strict Hispanic family. My older siblings being my sister still lives with us, my brother recently got married. I just started my first year in college and Im doing well. But I feel like my family still controls me, when I go out they expect a phone call from the time of my arrival and departure, to who Im with and where Im going. Im in a relationship but my sister tends to threaten me of ending the relationship, yet I only see my boyfriend a day out of the week, two if we’re lucky. My older sister tends to dominate my mother’s authority sometimes and I believe it’s not fair. I plan on discussing this issue with my therapist to see what advice she can give me. I also plan on getting a job and moving out soon but my mother has told/ warned me if I leave that the financial support shall be gone. Im scared yet willing to take the risk but I do need help please. Im willing to provide more information if necessary, thank you and have a good day. A: I do understand how difficult this is. You want the independence you see other American women your age having at college. But you come from a traditional Hispanic family that is more protective. You want to be able to make your own decisions but it’s hard to cut loose from the financial and emotional support that your family offers. It can look like there is a big cost to whatever you do. I’m impressed that you are willing to work hard and perhaps move out. That shows courage and strength. I hope it doesn’t have to come to a blowup with your family for you to be with your boyfriend and to pursue your own dreams. I’m very glad you found a therapist to help you. That’s the person you should be talking to about these issues. She can learn your whole story, where I only have your short letter. She can provide you with ongoing advice and support. I’m sure the two of you can figure out how you can gain more independence and still be connected to the people you love. You may even want to invite them to come to a session or two to help you in the project. I wish you well. Dr. Marie

I'm gonna try and be fairly brief in this post on the paper by Valerio Napolioni and colleagues* (open-access) looking at plasma cytokine profiles in cases of autism and their asymptomatic siblings. Brief because (a) the paper is open-access and (b) the participant groups (autism: n=25; sibling controls n=25) were relatively small so one has to be quite careful in extrapolating the findings with any large degree of confidence.Siblings by Paul Klee @ WikiPaintings Just in case you are new to cytokines, we are talking biological signalling and communication, and in particular, the language of inflammation both pro- and anti-inflammatory (see this post).With the autism spectrum conditions in mind, research into cytokines has filled quite a few peer-reviewed papers** from lots of different perspectives (see here and here for example). The main message so far is that it is complicated as per everything about autism and immune function.Despite the quite small participant group, the Napolioni paper does seem to be an important paper for a few reasons:They report no overall difference in cytokine profiles - measuring 40 cytokines - between cases of autism and their asymptomatic siblings. This despite the fact that autism symptoms and total IQ measures were different. That was the paper's headline.But.... "the cytokine/chemokine levels in our subjects did correlate with the quantitative clinical traits" or in other words, certain analysed parameters seemed to match with level of severity of autistic traits as measured by schedules such as VABS and SRS. "IL-1? appears to be the cytokine most involved in the quantitative traits".When looking at the children with autism according to various clinical subgroups - non-verbal, functional gastrointestinal (GI) issues, history of regression, history of allergies - a few correlations were noted. So, children who were non-verbal seemed to show higher levels of cytokines such as IL-10, one of the more anti-inflammatory cytokines. Children with accompanying GI issues seemed to show higher levels of more pro-inflammatory cytokines like IL-1? and IL-6 compared with those without GI problems. Reported regression as part and parcel of symptom onset also seemed to show some correlation with specific cytokines too.As the authors point out correlation does not imply causation. Such that just because they reported connections between cytokines and functioning and other factors does not necessarily mean that these observations are causative of autism (or anything else). That being said, as I hinted before, this is not the first time that cytokines and their connection to immune function have been discussed in the autism research literature (see yet another example of this here***); many correlations in similar directions makes for some interesting discussions at least.That headline that children with autism and their siblings did not significantly differ in their cytokine profile carries a few possibilities for interpretation. The authors suggest that this could be evidence of "an ‘autism endophenotype’ that expands immune dysfunction to family members who are seemingly unaffected by the core symptoms of autism". One might also say the same thing about the Gondalia paper**** on gut bacteria in cases of autism and siblings (see here).Assuming that the broader autism phenotype (BAP) does not come into play here, one might speculate that (a) cytokine profiles are not related to the presence of autism, or (b) that the manifestation of autism, some autism, is representative of cytokine involvement but in addition to other factors in terms of the affected sibling - "when an environmental stress (for example, prenatal exposure to environmental toxins, viral and bacterial infections, parental microchimerism, etc.) occurs during development". This last point takes me back to that 1971 John Money study on the appearance of familial autoimmune related conditions 'round about' the presence of autism and a similar cor

Take Home Message: Hyaluronic acid injections decrease factors related to collagen degradation. Some blood tests may differentiate responders and nonresponders to these injections. Knee osteoarthritis, one of the leading causes of disability, has no cure and current treatments commonly involve medications to decrease inflammation and pain. Hyaluronic acid (HA) injections have become a popular form of treatment for knee osteoarthritis. However, the mechanism of action has yet to be determined. Therefore, the authors examined serum biomarkers of collagen breakdown (Coll2-1 and Coll2-1 NO2) in 45 patients with various stages of knee osteoarthritis before (-15 days), at the time of injection, and following treatment (30 and 90 days) with HA injections.... Henrotin Y, Chevalier X, Deberg M, Balblanc JC, Richette P, Mulleman D, Maillet B, Rannou F, Piroth C, Mathieu P.... (2013) Early decrease of serum biomarkers of type II collagen degradation (Coll2-1) and joint inflammation (Coll2-1 NO2 ) by hyaluronic acid intra-articular injections in patients with knee osteoarthritis: A research study part of the Biovisco study. Journal of Orthopaedic Research, 31(6), 901-7. PMID: 23423846 Early decrease of serum biomarkers of type II collagen degradation (Coll2-1) and joint inflammation (Coll2-1 NO2 ) by hyaluronic acid intra-articular injections in patients with knee osteoarthritis: A research study part of the Biovisco study.

I am fairly convinced that my wife has some degree of bi-polar disorder. She goes into fits of rage over any question about her, her parents or upbringing. She constantly belittles me and talks bad about my family to the children. It has escalated in recent years with her attempting to push me, going into 20 minute tirades where she brings up everything that I had done over the last 12 years and her drinking has increased. She drinks to the point that she is carried out of neighborhood parties with the children crying out of embarrassment then blames me. Those who dont tolerate it are ‘fake people’ but the others are ‘true friends’ and she has been going out and staying out all night this past month. What is of greatest concern is that her explosions have increasingly come in front of the children resulting in them crying hysterically and her threatening to ‘kick me out’. She yells at them and then goes into a dialog of how much she does for them and how lucky they are. It is very stressful but I need confirmation that this is what I am dealing with and how do I proceed? A. It’s unclear whether your wife has bipolar disorder. Emotionally she is unstable but it might be due to her drinking. The fact that she is drinking makes it difficult to determine if a mental health disorder is present or if her drinking is the main problem. It may be a combination of both but I cannot make that determination based on this short letter. What is clear is that your wife’s drinking is excessive and is causing a great deal of distress for your marriage and for your children. Both you and the children are subjected to her tirades. It’s abusive, unacceptable and something needs to change. Encourage her to seek psychological treatment or inpatient rehabilitation if necessary. If she is unwilling to seek treatment, then you must take action. This might include seeking psychological help for yourself so that you know how best to deal with your wife or temporarily moving out of the home. Your children should not be subjected to your wife’s tirades. It most certainly frightens them and it’s abusive. You may also want to consider an intervention. By this I mean you and members of your family come together as a group and ask your wife to seek help. During the intervention, members of the group describe how her behavior is affecting them and ask her to receive help. Perhaps she would be willing to seek help if she knew how her behavior was negatively affecting friends and family. I can confirm the fact that there is a problem but I cannot determine the precise problem that is causing your wife to behave in such an unstable manner. Utilize the help of mental health professionals to assist you in dealing with your wife and children. I firmly believe that trained mental health professionals can give you the best advice about how to proceed. I wish you the best of luck. Please take care. Dr. Kristina Randle Mental Health & Criminal Justice Blog

Hi, one of my friends that I have is becoming very toxic to me and I don’t know what to do. She and I met over a decade ago when we worked in the same place. She is on the one hand, tries to be nice, loyal, helpful if I have a difficult situation, knows me well, etc. but on the other hand, she is a very bitter, critical and harsh person- and lately doing it to me as well. I can’t blame her, she is all alone except for her dh and her father (she doesn’t get along w/ her father). She has no children and no job, and has a hard life. However, every time I talk to her, she criticizes me, or the way I do thing, or she is the only one who knows how to do xyz, everyone else is stupid etc. As it is, I have low self confidence and this is very hard for me to take. For example- she’ll ask me how I make a certain dish, and when I tell her-she says in an amazed voice- ‘that’s how u make it. ugh’. (mind you, everyone says I’m a great cook.) And of course if she gives me advice or says I made a mistake, she says she tells me the truth to be helpful, because she cares- but she is so tactless, its almost nasty. I don’t want to cut her off totally- firstly bec I feel bad for her, and also bec. then I will have no friends. So how can I become more immune to her comments? A: It is time for new friends. While I don’t recommend a complete cutoff I do think that everything you’ve said indicates you need to find more people to connect with. Try taking a class, joining a group, volunteering, attending free lectures, etc. In other words, start increasing your contact and connection with other people so you have more choices. Once you have options it will be easier to deal with your friend. Wishing you patience and peace, Dr. Dan Proof Positive Blog @ PsychCentral

It may be a pure coincidence, but at the San Francisco Museum of Modern Art they're displaying a tower of brains during APA week. Meanwhile, the DSM5 is officially out: And if that weren't enough chaos for you, we have the obligatory APA protesters. (Do urologists get protesters at their conventions?) I'm looking forward to meeting with Roy and our longsuffering Clinical Psychiatry News editor for dinner tonight.----- Listen to our latest podcast at mythreeshrinks.com or subscribe to our rss feed. Email us at mythreeshrinks at gmail dot com Our book is out now.

Is 'cloning' appropriate terminology for somatic cell nuclear transfer derivation of human embryonic stem cells?... Tachibana, M., Amato, P., Sparman, M., Gutierrez, N., Tippner-Hedges, R., Ma, H., Kang, E., Fulati, A., Lee, H., Sritanaudomchai, H.... (2013) Human Embryonic Stem Cells Derived by Somatic Cell Nuclear Transfer. Cell. DOI: 10.1016/j.cell.2013.05.006 Human Embryonic Stem Cells Derived by Somatic Cell Nuclear Transfer

. In honor of 100 years of psychiatry at Johns Hopkins, Baltimore cinematographer Richard Chisolm, along with Kindall Rende, created this movie of members of the department talking about psychiatry at Hopkins. Many of the people shown in the film have been guest bloggers on Shrink Rap, and they include our mentors, colleagues, and friends. Both ClinkShrink and I are proud to be members of the department and we are both grateful for the education we've received, so we hope you'll spend a few minutes watching Richard's tribute.----- Listen to our latest podcast at mythreeshrinks.com or subscribe to our rss feed. Email us at mythreeshrinks at gmail dot com Our book is out now.

In two recent posts, I have referenced a relatively-average psychologist (again, this psychologist need not bear any resemblance to any particular person, living or dead). I found this relatively-average psychologist to be severely handicapped in their ability to think about … Continue reading →... Smallegange, R., van Gemert, G., van de Vegte-Bolmer, M., Gezan, S., Takken, W., Sauerwein, R., & Logan, J. (2013) Malaria Infected Mosquitoes Express Enhanced Attraction to Human Odor. PLoS ONE, 8(5). DOI: 10.1371/journal.pone.0063602 Malaria Infected Mosquitoes Express Enhanced Attraction to Human Odor