Dad's Absence Affects Neurobiology of Offspring

Scientists at the Research Institute of the McGill University Health Centre (RI-MUHC) have discovered that an absent father during critical growth periods can lead to social and behavioral impairments in adults. This is the first study of its kind to correlate paternal deprivation and social attributes with physical changes in the brain.

"Although we used mice, the findings are extremely relevant to humans," says senior author Dr. Gabriella Gobbi, a researcher of the Mental Illness and Addiction Axis at the RI-MUHC and an associate professor at the Faculty of Medicine at McGill University. "We used Californiamice which, like in some human populations, are monogamous and raise their offspring together."

Researchers were able to control the environment in which the mice were raised, including the factors among the different groups.  As a result, mice studies may be clearer than human studies claims Francis Bambico, a former student of Dr. Gobbi at McGill and now a post-doc at the Centre for Addiction and Mental Health (CAMH) in Toronto.

Researchers compared the social behaviour and brain structure of mice in different groups; those raised with both parents and those raised by their mothers. Findings show that mice raised by single mothers experienced abnormal social interactions and were more aggressive than those raised with both parents present. In addition, these findings were more prevalent among female mice.  Furthermore, females also experienced an increased sensitivity to amphetamine.

"The behavioral deficits we observed are consistent with human studies of children raised without a father," says Dr. Gobbi, who is also a psychiatrist at the MUHC. "These children have been shown to have an increased risk for deviant behavior and in particular, girls have been shown to be at risk for substance abuse. This suggests that these mice are a good model for understanding how these effects arise in humans."

Further studies may uncover a clearer reasoning for such findings.  Is it merely the presence of a male role model?  Could it be that two parents, regardless of gender, have more influence than one?  Could male mice be more sensitive to amphetamine if raised by fathers alone?  Many questions remain for future studies to uncover, however this research demonstrates that the role of the father and/or the presence of both parents during critical stages of growth appear to be relatively important in children's mental health development. 

Dads: How Important Are They? New Research Highlights Value of Fathers in Both Neurobiology and Behavior of Offspring

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College Mental Health as a Specialty

I chose to focus my career on college mental health (CMH), or college counseling, in approximately 1987.  That was my first year in my doctoral program in counseling psychology.  Perhaps it was the time, perhaps the context, but I definitely perceived CMH to be a "field" of study and work.  I recall others being interested in pursuing this same career path then and especially during the early years of my professional life.

If I have learned anything from more than two decades of work in this field it is that CMH is in fact a specialty.  Explaining the nuances in this work could fill more than one volume, much more space than what is offered here.  Starting with an example of definition, the American Psychological Association (APA, 2011) defines a specialty as follows:

"A specialty is a defined area of professional psychology practice characterized by a 
distinctive configuration of competent services for specified problems and populations. 
Practice in a specialty requires advanced knowledge and skills acquired through an 
organized sequence of education and training in addition to the broad and general 
education and core scientific and professional foundations acquired through an APA or 
CPA accredited doctoral program. Specialty training may be acquired either at the doctoral or postdoctoral level as defined by the specialty."

There are professional organizations devoted to this specialty, about some of which I have posted previously.  A short list of American organizations is provided here:

• Association of University and College Counseling Center Directors
• International Association of Counseling Services, Inc.
• American College Counseling Association
• Section on College and University Counseling Centers, Division 17, American Psychological Association
• Commission for Counseling and Psychological Services, American College Personnel Association

But these are just formalities, and not included are the many college counseling centers which provide formal training opportunities including practica and internships.  The essence of the specialty lies in the nature of the work itself.  Some hallmarks of a competent approach to this field include:

• A thorough understanding of the holistic development of late adolescents and young adults as it relates to academic success and personal growth
• A broad range of skills in the area of psychotherapeutic approaches to common issues faced by college students
• An appreciation for the importance of outreach and prevention education programming on a college campus, including the skills of planning, delivery and evaluation of these activities
• A thorough and competent approach to delivering consultation services to members of a college campus community, including faculty, staff, parents, and others
• Where possible, a comprehensive mission of training graduate students in mental health professions in the CMH specialty

Much harder to articulate is what lies at the heart of this type of work.  The nuances mentioned above relate to the skills involved in managing very complex dynamics in multiple and sometimes conflicting work relationships, the urgency involved in responding to the needs of both the individual and the community, and the promotion of the full and genuine identities and life trajectories of students in this context.  If I was forced to explain one view in as few words as possible, which in fact I am in this space, I would offer the following statement:

"CMH is the training for, application, and on-going study of a range of psychologically-oriented human services focused on the academic success and personal growth of college students, with a full understanding of the complete context in which they function, including responsiveness to the needs of all who relate to, work with and serve them, and the successful management of professional boundaries with all involved such that the goals of the individual and community are promoted."

Diagnosis spotlight: seasonal affective disorder

Our environment has a strong influence on our mental health. In fact, an entire disorder is dependent on the time of year: seasonal affective disorder (SAD). Often referred to as the "winter blues," this disorder typically follows an increased depression that begins in the fall and increases as the winter moves on. In some cases, however, the disorder starts up in the spring and peaks in the summer.

Symptoms vary between winter and summer SAD. According to the Mayo Clinic, symptoms of fall and winter SAD include depression, hopelessness, anxiety, loss of energy, a heavy or "leaden" feeling in arms or legs, social withdrawal, oversleeping, loss of interest in activities you once enjoyed, appetite changes (especially a craving for carbohydrates), weight gain and difficulty concentrating. Spring and summer SAD, on the other hand, is demonstrated through anxiety, trouble sleeping, irritability, agitation, weight loss, poor appetite and an increased sex drive.

It's easier to dismiss a problem if it goes away on its own. It can take a long time for someone to be motivated to get help and since SAD dissipates after a few months, some people will never seek treatment. The problem is that this is a cyclical disorder that returns year after year, meaning that it isn't actually going away. 

SAD, though dependent on the seasons, is not any less severe than other forms of depression. It should be taken just as seriously as "regular" depression. This means actively seeking treatment is just as important. The most commonly used treatments are light therapy, medications and psychotherapy.

Light therapy (also known as phototherapy) involves sitting in front of a box that emits specific wavelengths of light. This treatment is based on the idea that a lack of sunlight is partially to blame for the illness, a theory that is supported by increased rates of winter SAD in the north. This is the least invasive treatment and a good first step. Make sure you buy a quality box and consult with your doctor. How long you expose yourself to the light and what time of day you do so is important and should be determined by a professional.

SSRI antidepressants are also used to treat SAD, especially in more severe cases. It can take several weeks for the medication to work, so if you know you know have a yearly problem with SAD, you might want to start a regimen before winter (or summer) hits. Make sure to not go off the medication before your doctor recommends it, even if you feel better. 

Psychotherapy can also be effective in treating SAD. While you can't control the coming and going of the sun, you can control other factors that might be influencing the SAD. A therapist can offer suggestions for managing and reducing your symptom. A therapist can also possibly get at other underlying causes of and contributions to the depression, seeing as it is rarely only one thing that is the root of the problem. 

It's unnecessary to suffer from seasonal depression year after year. If you or someone you know struggles at a particular time of year, don't dismiss it. The temporary nature of the disorder does not reduce its seriousness. Schedule an appointment with a doctor or therapist to further explore what your options are in treating SAD.

Do you get more symptomatic at certain times of the year? What has helped you? Share your thoughts in the comments.

My take on meds

Feel free to ignore this post if you don't want an opinion piece. I just feel that since I will be talking about medication, it's probably best that I explain my stance to provide some context. 

There's so much good that has come from modern medicine. This includes a wide assortment of medications that help treat and even prevent certain conditions. These include entire categories dedicated to mental health issues. Due to the fact that we don't know enough to not be experimental, new discoveries are made by chance. For instance, anti-seizure medication can be used in the treatment of personality disorders. It's a frontier we have yet to conquer.

I have a great level of respect for those who dedicate their lives to finding ways to improve and extend our lives. Unfortunately, the pharmaceutical industry as a whole is not run by philanthropists who throw money at it. It's a business. This means that they have to make money. The competition can be healthy in terms of innovation, but it has to be financed. This is how Prozac got renamed Sarafem and prescribed for PMS. Once the original use for a drug has been tapped into, it's time to find ways to keep making money off of the same formula. Do you have to take four pills a day? We just made a different one that does the same thing, but you only have to take it once! You think anti-psychotics are reserved for schizophrenia? No, they're also used for autism, dementia and even insomnia.

Honestly, it's a really complex system and I'm not here to preach about it. But since medication is a significant aspect of the mental health industry, I can't ignore it. In order to offer a respectful climate for discussion of something so attached to opinion, this is the perspective I am coming from:

• Medication has the potential to significantly improve and even save lives in the mental health field.

• Some people need medication. They have exhausted all their options and cannot find anything else that is sufficiently effective.

• It is not our job to judge whether or not someone needs medication. Don't think your sister needs lithium? It's the job of her and her doctor to figure that out. Think your friend needs some anti-anxiety pills? It's not your call.

• Side effects are a factor that should be taken into consideration when prescribing medication.

• When it comes to children, teenagers and young adults, special precautions need to be taken and other approaches should be more carefully considered. While the body and mind are still developing, a cost-benefit analysis is definitely warranted.

• Are we overprescribing? Probably. I refuse to believe all my classmates who take Ritalin or Aderall actually have attention deficit hyperactivity disorder (ADHD), a childhood disorder that doesn't spontaneously emerge in college.

• Never encourage or support someone in going off their medication without proper medical supervision. Not only may it be inappropriate in terms of treatment, but not regulating the tapering off of a substance can cause withdrawal symptoms and other serious – possibly permanent – complications.

• There are alternative approaches that can be taken, and that's okay, too.

• Ultimately, it's about getting better. Whatever works (and is relatively healthy) is great!

I understand completely if you disagree. I don't claim to be an expert. I'm just being honest about where I'm coming from so that any biases I have are pre-announced. 

I'm back

I apologize for my unannounced and unexpected hiatus from this blog. A lot of things came up very quickly and I had to prioritize other areas of my life for the last several months. I'm starting back up again, though, so look for more posts in the near future.

Thank you for your patience with this bump in the road.

Effective Campus Consultations

In the college counseling world, consultation refers to delivering mental health expertise to concerned third parties, such as faculty, staff, parents, and other community members.  On most campuses, the community sees the counseling service as a valuable resource which offers all some assistance in helping students effectively.

This aspect of services is rife with both potential conflict and opportunity (it's amazing how these two things often go together, eh?).  On the one hand, the student is always the focus of services and often also the client; on the other hand the institution is always the client, the corporate client in fact.  There are a few times when the needs of both are in conflict.  I submit, however, that such occasions are rare.  Mostly, there is enormous overlap among the needs of the two.  Indeed, each actually wants the same thing: to retain and graduate young adults.  My direct experience has been that when there is conflict it's often because one or both are nurturing needs which are unreasonable, though that is of course open to plenty of debate.

So, there are some tips on delivering effective consultations on campus.  In no particular order, here are a few.

• Establish the identification of the primary client, and do it early and often.  If the student about whom someone is concerned is a client of the center, they are the primary client, and the obligations to them are paramount.  In this scenario the institution becomes a secondary client, though in this context this does not mean its needs are inferior.  It's just that they must be addressed by someone who does not have a dual role with the student unless the student has authorized such activity.
• Respond promptly, every time.  The fortunes of college mental health rest on our showing up.  Always.  It is often expensive to do so, considering the labor involved.  But there is a huge return on investment.
• Don't just say no; find a way to help and tell them you will do so.  Successful businesses put the consumer first.  There is no reason why we should not do this as well.  Even when needs conflict or dual roles exist, there is always a way to be helpful.  It may take some time and creativity to pull this off, so one could always say "I'm not sure how to help you, but keep talking to me and I will find a way."
• Establish and maintain clear boundaries and expectations when needed.  At the same time, some requests are clearly inappropriate.  Such as when someone asks for privileged information and there is no authorization for same, nor is there any risk for harm to self or others.  You could be the FBI or a parent or an administrator.  It does not matter.  Abrogating the therapy relationship in this way can be fatal to therapy, now and perhaps well into the future for a student.  That's a really bad thing.  At the same time, there may be a need driving the request which can in fact be satisfied.  Figure out what that is.
• Keep your word and be consistent.  Whatever happens, do what you say you will do and do it each time.  Since we're all human here, we make mistakes and no one can rightly tell you that you can't.  But if you do, own up to it and set it right whenever possible.

Consultations are wonderful opportunities to get things back on a good path, for the student as well as the community.  Often the circumstances behind the consultation represent the logical though negative conclusion of unhealthy relating and expectations.  It is a kind of bubble which needs to burst, but all involved sometimes prevent or avoid that from happening.  An effective consultation facilitates the bursting in a controlled manner, so that maximum learning and change can occur.  Which is exactly what everyone needs, whether they want it or not.

A smoking ban for mental health workers at the workplace

To force a breakthrough in the smoking culture in psychiatry it should be prohibited for mental health staff to smoke in the work place. There I said it! (and yes I agree it should be like that everywhere in health care but in this blog I will focus on psychiatry).
Last time I said I would like to see a smoking ban for all mental health staff within hospital grounds and during home visits was when I arranged a meeting for mental health workers about psychiatry, health and sports. Many smokers weren’t pleased and that’s an understatement. Some were very annoyed and kind of hostile as if this was denying them a civil right. Many many health workers that smoke with patients say its good for bonding but its just an excuse to maintain the smoking culture.
It’s a challenge for patients to quit smoking in psychiatry where a lot of people smoke. They get discouraged. Mental health workers may often tell the patient that it’s too hard to quit with mental illness, that it stresses them out too much. And of course it’s quite an effort for them but I have seen enough to prove that it is not impossible. Sometimes I wonder if staff who smoke feel threatened by the brave attempts of patients who want to quit when they can’t manage to quit themselves.
Addiction to nicotine is the most common form of substance abuse in people with schizophrenia, who are more than three times more likely to be addicted to nicotine than the general population. The relationship between smoking and schizophrenia is complex. People with schizophrenia perceive certain benefits from smoking but at the same time it’s threatening their health and wellbeing in a serious way and can make antipsychotic drugs less effective. Heavy smokers often need higher doses of medication.
People with schizophrenia have a shorter life expectancy (up to 15-20 years shorter) than the average population and the main cause is smoking.
Over the years I have seen many people with mental illness die young because of smoking related diseases like heart failure, different forms of cancer, strokes, COPD. People in psychiatry can get help with quitting drinking, quitting street drugs, quitting benzo’s, quitting gambling… but there’s usually no specialised help for quitting or reducing smoking for people with mental health problems. Smoking doesn’t seem to have priority in the smoking culture of this specific field of health care with mental health staff having the highest percentage of smokers of all healthcare staff.
But with worrying statistics on physical health problems among people with mental illness we need clear measures. And mental health workers who are addicted to smoking should get over themselves and only practise their addiction outside the hospital gates and out of sight of patients, including in outpatients and in community settings. After all our goal is to improve and encourage health from a holistic point of view. Staff who smoke give the wrong message. Smoking should be banned and it should be the responsibility of managers in mental health care to enforce those bans.
I have been giving a “decrease-smoking-course” for people with mental illness for a few years now. The course is free. Most of the attendees have schizophrenia. There is always one chair for a mental health worker who wants to quit. They can attend the course during work hours. Thanks to the course we have a smoke free team now.
First it was called a “quit-smoking course” but we got very few subscribers. Quitting seemed a step too far for many. So we changed it to “decrease-smoking-course” which consisted of 10 sessions including a smoke break of 5 minutes. Soon we had a waiting list.
The first session was about smoking habits and keeping a smoking diary to get insight in smoking habits and coping. Many people started to smoke when they were admitted to a mental hospital for the first time. One of the patients started smoking when she was admitted with psychosis at age 27. She told us:
“Everyone, patients and nurses, seemed to smoke so I thought it might be helping and some nurses even promoted smoking by giving me a cigarette even though I didn’t smoke. And they took out the patients who smoked more often than the ones who didn’t smoke. So some started smoking to be with the others.”
Now at age 45 her GP told her she had to quit smoking because she had COPD. She joined the course and eventually managed to quit.
Most people who attend the course don’t quit but decrease a lot. That’s important improvement too. People who go from 60 to 10 cigarettes are not unusual. We involve psychiatrists, family, GP’s and mental health workers as supporters to make their resolution a success.
We notify and work closely with all people involved in their treatment and give information on how to offer support. The psychiatrist monitors blood levels especially when patients are taking Clozapine and sees the patient more frequently to adjust medication doses when needed. Smoking cessation can lead to higher plasma concentrations and potentially more side-effects. With Clozapine their levels can raise in a dangerous way.
Quitting smoking with this group should be monitored closely whether there is any exacerbation of symptoms or medication side effects, so possibly the dose of neuroleptic medication needs to be adjusted. Since quitting smoking is a challenge we make sure that the patients get extra support. Nicotine replacement methods may benefit their effort to quit.
Every mental health trust should offer specialised quit or reduce smoking support for patients and mental health workers.
I’m not promoting a smoking ban for patients. I’m very much against that. In the hardest times we shouldn’t force patients to quit. But I strongly believe that a healthier and more encouraging environment will help people to find the motivation to reduce or quit smoking and improve their wellbeing.
And that’s our job as mental health workers.