Early Emotional Neglect May Predict Strokes

New research conducted by the Rush Alzheimer's Disease Center at Rush University Medical Center suggests that emotionally neglected children are at risk of stroke as adults. 

"Studies have shown that children who were neglected emotionally in childhood are at an increased risk of a slew of psychiatric disorders. However, our study is one of few that looked at an association between emotional neglect and stroke," said study author Robert S. Wilson, PhD, a neuropsychologist at Rush.

Researchers’ selected 1,040 participants aged 55+ without dementia from the Memory and Aging Project were surveyed on physical and emotional abuse before the age of 18. Participants were questioned on such areas as how much love they felt from their parents or caregivers as children, whether they felt afraid or intimidated by their caregivers, the method of physical punishment suffered and other questions relating to divorce and family finances.

The participants were followed over a period of 3.5 years. In that time, 257 participants had died. Of the deceased participants, only 192 had brain autopsies, which revealed that 89 of them had experienced strokes. Furthermore, forty of the participants were said to have had strokes based on medical history or an examination.

Furthermore, participants that expressed moderately high levels of emotional neglect in childhood were nearly 3 times more likely to experience a stroke than those reporting moderately low levels of emotional childhood neglect, even when other factors such as diabetes, physical activity, smoking, anxiety and heart problems were controlled.

"The results add to a growing body of evidence suggesting that early life factors such as traumatic childhood experiences influence the development of physical illness and common chronic conditions of old age" says Dr. David A. Bennett, director of the Rush Alzheimer's Disease Center and co-author of the study

Of course results may not be completely reliable since this study relies on a self-report of recalled events many years later, which may be even further clouded given the nature of the potentially traumatic memories.

Emotional Neglect in Children Linked to Increased Stroke Risk Later in Life

© www.mentalhealthblog.com

The Silver Lining in Today's College Student

From the beginning of time, I suppose, each generation has been identified as headed to hell in a hand basket.  Or so the pundits would have us believe.  Teens and young adults are favorites for social critiquing and waxing philosophical on the demise of civilization as we know it.  Little awareness of the irony involved is apparent; what about the older adults who have a more direct role in today's events?  While the "adults" work feverishly to destroy each other in various parts of the world, for example, one group of Christian, Jewish and Muslim teenagers are hoping to better understand and communicate with each other.

This is not to say that troubling trends or themes don't exist.  In their book Generation on a Tightrope: A Portrait of Today’s College Student, Arthur Levine and Diane Dean write about such themes in young adults.  They tell us that they are at once low in resilience and high in self-confidence.  They think their grades don't actually reflect their performance.  They embrace social media extensively, yet lack actual in-person communication skills.  They see themselves as worldly, but can't identify world leaders.  And so on.  There are data to support these observations.  But do these data mean they are a hopeless, "broken generation", or just different from us older, wiser folk?  I vote for the latter.

Jonny Wakefield, himself a college student from Canada, would vote similarly, I think.  He warns of the dangers of such trendspotting in the lives of young adults.  He posits, rightly, that sweeping generational narratives are both imprecise and subject to self-fulfilling prophesies.  Which, in the case of young adult mental health, is precisely what we don't want to invoke.  Do we really want college students to see themselves as feckless and entitled losers?  I think not.

It might just be that we do not understand what we are seeing.  It may be that youth are doing what each generation did before them: doing their best, with what we gave them, to adjust to a challenging and rapidly changing world.  Sure, some of what they will do will fail.  Just as my generation did, and as my parents' generation did before me.  They will undoubtedly learn some hard lessons along the way.  But the seeds of seeing and doing things differently are already in them, and those will bear surely some fruit later on.  When I encounter young people in my work, I detect a level of energy and boundary-busting creativity that I don't see as much in my peers.  That is cause for hope, my friends.  Perhaps they will be able to make things better in the world, if we celebrate and cultivate their strengths rather than focus on their shortcomings.

The Failure and Growth Cycle

Some view western culture, and American culture in particular, as a society which places a premium on the success and advancement of the individual.  Critics of this view argue that this premium diminishes some individuals and groups, but others say this does not necessarily have to occur; that one can promote the interests of the individual and society at the same time.  See the works of Ruth Benedict and John Kenneth Galbraith for references on that subject.  In my experience it takes an educated and enlightened individual to pursue "success" and also orient that success to higher purposes, such as benefiting larger and larger circles of human beings.

Enter typical college students and their families.  As noted elsewhere in my blog they tend to arrive being very focused on pragmatic issues such as living arrangements and choice of major.  There is a tremendous amount of energy focused on moving the late adolescent and young adult along a continuum of advancement, however that may be conceived in family ethics and values.  Getting good grades, joining the "right" organizations, and networking for future employment are, in the minds of those involved, locked in rather tightly.  Variance from this template is often frowned upon, if not met with punitive consequences.

But college life is a crucible for the formation of both individuality and responsibility or conscience.  Mistakes and failures are inevitable, and the stuff which catalyzes the higher calling of the young adult.  In his book, How Children Succeed, Paul Tough theorizes that non-cognitive skills such as persistence, resilience and fortitude are actually the bases of future success, though it is cognitive skills that often get the attention.  In this view mistakes and failures are desirable, the launching pad for growth.  In short, one gets intimately acquainted with one's self, with both talents and foibles, through a cycle of failure and growth.

Such is the process of learning who we are, what we can do, and the limitations presented by our perceptions and biases.  The process of "advancement" is much more earthy and sobering than western mythologies would have us believe.  It is very much two steps forward, one backward, a thousand blind alleys to ten workable paths.  And this is to be embraced, not belittled.  Great achievers like Newton, Edison, Einstein, and Carver all said so.

Families can be wonderful allies in the young adult's search for self by understanding this cycle, by welcoming it, and by patiently waiting for their children to learn life's lessons.  Students will succeed in their journey to self-hood by minimizing anxieties about social perfection, or, better yet, rooting them out altogether.  It takes courage to advance.  Fear won't get us there.

How to improve dental care in psychiatry

Dental care is poor and a disregarded health issue among people with serious mental illness. They are on a higher risk than average for tooth decay,inflamed gums and denture problems. Medication combined with reduced self care is an important cause. 

Poor dental health can increase the risk for social stigmatization / isolation and serious physical health problems. 
There is a causal link between poor oral health and cardiovascular disease and even stroke.Considering that people with serious mental illness like schizophrenia die 15-20 years earlier on average than the general population we have have enough reasons to take dental health seriously.

According to Danish research only 31% of schizophrenia patients complied with a regular annual dental check-up visit , compared to 68% in the general adult Danish population.  http://www.ncbi.nlm.nih.gov/pubmed/20584518 

Huge risks for poor dental care are: substance abuse diagnosis ,living in an institution or admission to a psychiatric facility for a minimum of 30 days  and male sex.

However Clozapine treatment, at least monthly outpatient visits , and age 50+ were associated with a lower risk for inappropriate dental care.

 

 Psychotropic meds can cause shortage or too much saliva or a change in acidity. Combined with poor oral health  this can make tooth decay occur faster. 

Many patients smoke. This increases the risk for gum disease : one of the leading causes of tooth loss in adults.

Smoking also slows down healing after oral surgery. It can damage gum tissue and receding gums leaving the roots of the teeth exposed. This can increase the risk of tooth decay and cause hot/cold sensitivity.

To improve the level of dental health we can help patients to

- Use less sugar and acidic products like carbonated drinks

- brush 2x a day preferably with an electrical toothbrush , they are much more efficient than ordinary brushes

- use fluoride toothpaste

- use floss or interdental cleaning brushes twice a day

- visit a dentist and support the visit if needed. We may ask the dentist about screening for the rate of salivation to see if the amount and acidity of the saliva is within limits.

- decrease smoking 
- Use 4 - 7 xylitol chewing gums or lozenges devided over the day. It needs to be 100% xylitol, no other sugar substitutes.This reduces dental    plaque. It stimulates the production of anti-bacterial saliva and remineralization of the teeth. And it partially replaces sugars in the diet (satisfies the ‘sweet tooth’) Using Xylitol chewing gum or rinse can decrease tooth decay with 60 %. For those who cant use gum or lozenges xylitol mouth water may be an option.

 In high amounts xylitol can have a laxative effect and cause flatulence.
- Inform patients that they should avoid to consume acidic products one hour before brushing  teeth. The surface of teeth is softened by the acid and can be damaged.

Let's make dental care a priority in psychiatry. After all it is basic care, not luxury .

Ethics and Meaning in College Life

Recently USA Today College ran a nice little piece concerning ethics in college.  The author, Miriam Schulman, assistant director of the Markkula Center for Applied Ethics at Santa Clara University, posed five simple questions for students to consider:

1. What is college worth to me?
2. How can I live with someone I don’t like?
3. How far will I go to be accepted?
4. Should I tell on someone who is doing something I think is wrong?
5. Is casual sex going to be part of my life?

Wonderful questions.  College life offers so many rich academic and personal experiences.  So many, in fact, that it is very easy to lose sight of fundamental questions which we all must face in our lives: Why am I here, and what am I going to do with my life?  From where I sit, working closely with students, a great many issues and problems could be averted, and a great many lives enhanced, through an active search for answers to these questions.  I believe Socrates said so way back in the misty past.

Students and their families are today focused on the practicalities of college life.  They rightfully ponder over where their students will live, what they will study, how will they spend their time, how will they make friends, and of course how they are going to pay for it all.  These are questions that do in fact need responses.  But the inquiry should not stop there, and all too often it does.  Without the bigger responses to bigger questions, students often live incongruently to their genuine identities and values.  They associate with people they don't truly respect.  They engage in activities which are meaningless or even harmful to them, which may result in a resume' packed with awesomeness but reveals experiences with little or poor quality.  A competent employer will see this instantly.

Spend time, ideally well before college starts, mulling over the big questions.  Set a target, well ahead in time and space, about where you would like to land and explore your existence.  One doesn't travel to another part of the world without having some sense of how one will live after arrival.  Why in the world would we cheat our future selves by not doing the same thing before our college and career journey begins?

No Need to Panic: The Art of Chilling Out

In addition to academic studies, many college students are learning about their limits with respect to stress and frustration.  As noted in a previous post, college is a time of new demands on many levels, which means adopting new stress management skills if one hopes to do well in life.


This learning is sometimes marked by peaks of anxiety and stress, of feeling overwhelmed, and of outright panic.  This can happen even in those for whom things are going well.  How a student manages these intense periods can make the difference between improving a situation or making it dramatically worse.  You can make things worse by impulsively acting on feelings of panic.  So let's talk about how to turn a stressful moment into an opportunity to make things better.

To manage peaks of stress one must learn to master physiological arousal, strong emotions and negative thoughts.  Most folks are aware of our body's built-in circuits of arousal, the fight-or-flight-or-freeze response in reaction to threat.  By the time someone reaches college, this system has been initiated countless times, and is so hard-wired as to be very rapid and even outside consciousness.  And therein lies the problem.  It has become a reflex for many, and their perception is they can't do anything about it.  But this is not true.  What many do not know is that our bodies also have built-in relaxation responses.  Just as our bodies and brains can mobilize against perceived threats, so too can they calm and slow down in order to access higher cortical processes or problem-solving.  This slowing down is essential for accessing our memory and use of judgment.  Panic is good for running, but horrible for higher thought.  If you've ever gone blank during an exam you know what I am talking about here.


So, here are some ways to calm down in a moment of intense stress:

• First, manage your breathing.  Sit down somewhere, and uncross your arms and legs.  Place one hand on your abdomen.  If you are breathing correctly that hand will rise and fall as your diaphragm muscle extends downward, allowing your lungs to fill with air.  Fix your gaze on a point in front of you, or close your eyes.  Slowly inhale through your nose, and slowly exhale through pursed lips.  Depending on body size, the breaths should be around three to five seconds apart.  In order to breathe well one must concentrate on these steps, and that is part of the secret because doing so is incompatible with worry or negative thoughts.  The other part of the secret is breathing of this type delivers a higher rate of oxygen to our brains than what occurs when we panic.  And oxygen makes our brains happy.  Keep breathing all the way through the wave of stress until you notice it is diminishing.  Practice your breathing at least daily, and every time you notice your earliest warning signals for stress and anxiety.  If you get good at it, you can abbreviate some of the steps and quickly enter a deeply relaxed state anywhere, at any time.  You can also learn more about helpful breathing.
• If you like imagery, close your eyes after your breathing and hold any image that you find peaceful, serene or relaxing in your mind's eye.  As you hold that image try to capture all the detail in the objects, sounds or smells of this place.  If you get distracted, don't worry about it, just keep going back to that image.  Another secret of stress management is taking yourself elsewhere, away from your troubles, in your own mind.  This acts like a reset button which clears the noise in our heads.
• Stress has physical components which increases tension in our muscles.  You can address this by tensing and relaxing, in alternating fashion, muscle groups from your toes all the way up to your head and face.  Create tension, for example, by clenching your fist as tightly as you can for a few seconds.  Then let it go, letting your hand fall as loose and limp as a wet noodle. And notice the contrast, the slightly warm or tingling sensation which comes from relaxing a muscle group.  The sensations are usually quite enjoyable.
• All of this is the easy part.  The harder part involves addressing our negative thoughts, our "stinking thinking".  Catch yourself engaging in typical thought patterns when under stress: magnification of problems, seeing problems as catastrophic, internalizing or personalizing problems, or hopelessness.  You can address these by saying to yourself "I am not thinking clearly.  I need to focus on one thing I can do today that will move me in the direction I want to go."
• Stress management is not complete until we examine what caused us to panic in the first place.  Such reactions occur for fairly specific reasons, such as over-extending ourselves,  poor preparation or coping skills, or perhaps failing to establish or uphold our personal boundaries in some way.  Once you are in a calmer state, and thinking more clearly as a result, spend some time problem solving about what needs to change.

Once these skills are developed a sense of confidence and resilience can be achieved.  Frustration tolerance will also increase such that future stressful moments are less likely to produce intense, reflexive reactions.  Like any skill, this takes practice, and there is no shortcut.  The skills are not a "cure" for what caused panic in the first place; that must be addressed through good judgment and decision-making.  But the skills are important management tools, the building blocks of which you already possess.  They simply await your time and attention.

College is a Trip

"We don't receive wisdom; we must discover it for ourselves after a journey that no one can take for us or spare us." -Proust

College is way cool, no doubt about it.  There are intellectual explorations and pursuits, exposures to a wide variety of people and cultures, sporting events, rich theatre and music opportunities, tons of ways to meet, socialize and party with folks from all over the world, and on and on.  The college years are a great time to learn and otherwise benefit from these experiences, and many students take full advantage of the possibilities.

At the same time, however, many students seriously underestimate the stresses and strains that result from this time in their lives.  During college there are incredible demands placed upon a student’s intellect, physical well-being, social skills, spiritual or philosophical orientation, and sense of personal responsibility.  This is true whether that student is from Manhattan or Opp, Alabama.  Every student I have ever known (including yours truly!) has had to endure an adjustment period during the crucial first semesters of college, and often during the subsequent years as well.  Some have roommate problems.  Some party way too much.  Some are overwhelmed by their new-found autonomy or freedoms.  Some struggle with isolation.  Some have to manage the negative behaviors of others.  While many students negotiate through these stresses productively, albeit fitfully, others experience meltdowns of one kind or another, and truly have trouble functioning well as a student.  Grades may suffer.  Conflicts with friends or family may emerge.  Depression or anxiety may root and take up residence in the psyche.  Though students may not realize it, college is a microcosm of the world at large, but compressed in both space and time.  What happens here can establish precedents for the future.  College is a trip, indeed.  It is a funky but delightful journey during which learning can occur in every dimension imaginable.

Some students arrive on campus with plenty of tools in their survival kit.  Caring parents.  Good health.  Sufficient funding.  Supportive friends.  Others seem to have been given tools of little value, sort of like a duffle bag with a pearl necklace, a chocolate cake, and a catcher’s mitt, and all for an excursion into the Amazon!  A few unfortunate students appear to have no tools at all.  Just as I have never yet met a student who didn’t have to adjust, so I have also not met a student who could not overcome such limitations.  I have known courageous, admirable students who were nearly homeless, or who were afflicted with a nasty medical or mental condition, or who were abandoned or abused, but succeeded nonetheless.  My hat’s off to these folks; they had more than their fair share of troubles but in the end weren’t defeated.

So college is a trip, and there are some tricks students need to know about in order to reach their destinations with sanity intact.

1.    Prepare for the adjustment.  Think ahead about what you will need, then find out where you can get it.  Manhattanites will need variety.  Oppians will need familiarity.  If you didn’t have to study in high school, well, get ready to.  If your parents did everything for you, learn how to do it yourself.  And so on.

2.    Quickly figure out the nature and source of your stress.  Are you strung out because you’re not sleeping?  Because your roommate is messy?  Because you can’t concentrate?  Because you’ve never been good at math?  Stress has origins.  Find out how it started.

3.    Get the support you need.  Every problem, and I mean every problem, has a solution.  Granted, some solutions are difficult.  But don’t freak out!  Instead, calm down, define the problem, and then learn what person or resource or service you need.  Need tutoring?  Chances are your school has it.  Need time management skills?  There is someone who can help.  Need to choose a major?  It's covered.  Need someone to talk to?  Counselors are here for ya.  Just take a look at the web or campus directories.  I’m always a little amazed at how many students don’t look for or don’t know what resources await them, or worse, choose not to use them.

4.    Don’t wait!  Do the first three steps early.  Don’t wait until your homesickness turns into depression, your public speaking anxiety becomes panic attacks, or your stress leads to insomnia or substance abuse.  If you get what you need early, chances are good it won’t take long to overcome the problem.  If you wait, it can take much, much longer.  Don’t believe the lie that it isn’t “normal” to have problems.  I have yet to meet anyone who didn’t have a few.

To take the college journey well, students need to periodically examine their survival kits.  Make sure the needed tools are in there.  If unsure, ask someone who’s been around.  Wisdom and a good deal of fun are there for the taking, if students care enough to equip themselves for the ride.