Young Shark Blog

Archive for October, 2011

Decisions in mental health treatment are often relatively subjective and clinical judgment is prone to errors. But must it be that way?

There is a solution, but, since this problem characterizes all of our work, finding it can be challenging. To start with, the clinical decision maker and the subject are both human beings, their reactions eluding any “empirically supported” treatment protocol. For example, the difficulty in arriving at an effective treatment plan is compounded by variations in the way mental health labels are understood by a clinician. Consider depression. When clients describe themselves as “depressed,” how do we know exactly what they mean? For one, “depression” may represent momentary discouragement. Another may be suffering from a relatively fixed biologically or personality disorder-based dysthymia. A practitioner’s choice of treatment strategy-psychotherapy, medication, or both-hinges on her or his impression of the etiology and character of the client’s depression.

To reduce this margin of error, together with colleagues at the Center for Collaborative Psychology and Psychiatry in Kentfield, California, I have evolved an approach that improves accuracy in assessment and treatment. This method emphasizes methodical fact finding, a careful clinical evaluation, the use of test data whenever possible, and continual feedback between the therapist, client, and, at times, significant others. Clinical progress is carefully monitored and revisions of the treatment undertaken as needed. We call this model “collaborative” to underscore the centrality of the alliance between therapist and client and, in the case of children and adolescents, between therapist and parents. Whenever possible there is a third member of the treatment team, a psychologist-assessor, who performs an initial psychological or neuropsychological evaluation of the client. Abbreviated assessments are repeated at intervals to follow the client’s progress.

Perhaps you are thinking, “All well and good, but can my clients afford these enhancements to treatment?” And you may be concerned that incorporating a third person into the treatment team will interfere with the treatment alliance. Further, what if the client becomes skeptical about the therapist’s clinical opinions, preferring the psychologist-assessor’s findings to the therapist’s?

While, of course, these issues arise, at the Center we have almost always been able to use them to our clinical advantage. In the sixty-plus cases we have completed, this third person, when properly trained in our collaborative technique, has virtually always made the treatment stronger. And, we have found that a third, consultative presence usually helps keep the client in treatment. Money is an individual issue, but we believe that if treatment is supported and focused by good psychological assessment, it will likely prove less expensive and more successful than one initially guided only by subjective clinical impressions.

Consider the following case:

Owen, 22, is bright, maybe brilliant, but moody and remarkably stubborn. Awkward and disheveled, picture him in a Parisian garret drinking absinthe and talking philosophy. Despite enormous potential, Owen wallows in a puddle of mediocrity. He falls in love hard, but relationships don’t last. Owen’s parents, two straight-arrow accountants, inevitably compare him to his older brother, a Harvard graduate bound for medical school. They unremittingly focus on Owen’s professional success, finding his unique needs and idiosyncrasies difficult to understand.

Owen was referred to me after being expelled from college for the second time in three years. A year earlier an incident of drunken rowdiness ended his stay at an excellent California university. He then managed to transfer to a rigorous private college where he failed to do his schoolwork. By the time of referral, his parents were so perplexed they were willing to let me “do anything” to help.

I arranged to meet with Owen’s parents and then Owen. As his parents had warned, Owen was moody and reluctant to receive help. “Nothing was wrong,” he insisted, “outside of my parents’ heavy-handedness and excessive worry.” Nonetheless, he agreed to meet with me regularly and then as we worked further, and as I became concerned that his problems might have a biological basis, to undertake neuropsychological testing and a full neurological workup. In fact, since he suffered from headaches, with the neurological workup he wanted an MRI of his brain done.

Why go to all this trouble and expense in assessing this relatively ordinary case? Typically someone like Owen would be swept into a once weekly treatment, possibly emphasizing CBT. The initial cost of these evaluations, without including the cost of psychotherapy, was to be about $3000. Using the bare bones approach, minus the testing and neurological workup, we could infer that Owen suffered from ADD and executive function problems. But would that be the whole picture?

The initial clinical assessment allowed me to start Owen on ADD medication while the full evaluation was being conducted. The neurological examination showed entirely normal results, as did an MRI of his brain. To further assess the cause of his headaches, he also had his cervical spine X-rayed. The results, again, were entirely within normal limits, leaving the source of his headaches obscure, most likely anxiety-induced. Neuropsychological testing underscored the seriousness of Owen’s combined ADD and temperamental idiosyncrasy. While irritability is frequently associated with both childhood and adult ADD, further testing was eventually needed to fill in the blanks about Owen’s diagnosis.

Six months later a supplementary set of psychological (personality) tests were done, in part to track Owen’s progress. My colleague, Philip Erdberg, conducted these and joined our treatment team as the “third member,” mentioned above. His unique take on the situation, building on the neuropsychologist’s, emphasized Owen’s intelligence and creativity. Owen craved constant stimulation setting up a vicious cycle: he’d get bored, seek novel situations, get bored again, and so on, becoming progressively more unproductive. Even if I were able to engage Owen in understanding and finding alternatives to this habitual pattern, there was every reason to expect that his proclivity for bailing out of situations would be repeated in our work together. So, I had to be especially creative in strategizing our work. I also collaborated with Owen’s parents, guiding them on how to manage him.

As we worked with his ADD and executive function problems, Owen agreed to ten to fifteen sessions of behavior training with a psychologist who specialized in ADD. Cognitive-behavioral interventions helped him learn to sit still and deal with his impatience. Owen also needed encouragement, in the form of confirmation that indeed he was a fish out of water and would have to stretch to comprehend and reach others who were not as smart and creative as he. Since Owen said he wanted to have friends, he acceded that adjusting his attitudes and behavior should be worth the effort.

Of course, we could have done an assessment with no bells and whistles, no neurological or neuropsychological assessment, no extension of testing. But since everyone was exasperated with Owen, a diagnosis and a “fix” were needed. I believe the extra expense of the neurological and psychological workups was more than justified-as a result, we knew exactly what we were treating. Hence, we could tailor the treatment and its interpersonal and behavioral components precisely to Owen’s needs. No wasted effort, money, or time.

There you have it: a procedure that includes careful assessment and in this case psychological testing, a medical evaluation, ongoing formal evaluation of progress, and structured collaboration between client and practitioner. I believe this assessment and treatment procedure is more accurate and reliable than the strategy we psychotherapists typically use; it is ultimately also likely to be more cost effective. True, I’m a psychiatrist, but so much of what I do is psychotherapy. I doubt that differences between our disciplines should modify the recommendations I have made. Given the subjective nature of our work, I believe that any movement toward therapist accuracy and accountability for treatment results should be welcome. I hope you come to share that conviction.

With appropriate obesity treatment individuals are not only improving their quality of life, it is saving lives. Unfortunately with most treatments 95 percent of the people who lost weight will gain it back. The end result or goal of any obesity treatment is to be able to achieve and maintain a healthier weight.

Obesity treatment is within your reach and there are several different types of treatment options to choose from. Weight management options include dietary therapy, OTC and prescription drugs, diet and exercise programs, weight loss clinics, surgery and several others. You should always discuss your options for obesity treatments with your doctor first.

A treatment plan that works for one person may not work for someone else. The treatment you choose will depends on your level of obesity, your health in general, your motivation and need to lose weight and which option you can afford.

No matter which obesity treatment you decide to go with it should include a long-term goal and lifestyle choices you will be able to live with. Take the time to explore you current eating and exercise habits, pay close attention to your strengths and weaknesses, this will help you in making changes to your eating and exercising behaviors. Be sure to check out the Internet for online communities that can help provide support for obesity treatments and information to strengthen efforts to lose weight and make lifestyle changes.

A proper diet and regular exercise not only lowers blood pressure it also can help prevent and even reverse type 2 diabetes. Exercise is good for the body, exercise will help improve emotional well-being, improve sleeping, improve flexibility, reduce appetite and lower LDL cholesterol. With exercise you will increase your metabolic rate which burns more calories. Steady aerobic exercise such as a 30 minute walk several times a week is one of the best ways to lose excess body fat.

Just like people come in all shapes and sizes the same is true for obesity treatments. With the help of your doctor you will easily be able to come up with the best treatment that you will not only be able to lose weight with but hopefully stick with for the rest of your life. Lifestyle changes that you can live with work the best. Choose lots of fresh fruits and vegetable, try to add more fish into your diet and cut back on fatty red meats, eat whole grains and drink plenty of water. Complement your healthier diet with a little more physical exercise and you will be well on you way towards a leaner healthier life.

Nexium is a medication that is known as a proton pump inhibitor and it is used by people that suffer from excessive acid production in the stomach. Many people suffer from this and it can lead to a range of associated health problems. Symptoms of a condition known as gastroesophageal reflux disease (GERD) as well as a condition called Zollinger-Ellison syndrome can be addressed through the use of this medication. It may also be used in the prevention of gastric ulcers that are caused by one of a range of factors and to help users to gain relief from persistent heartburn. For those that are directed to use Nexium it is advisable to look for the best deals and prices on this medication, as over the course of time you could save a fair amount of cash by finding the most competitive deals on this treatment. The cost of Nexium can vary depending on where you buy it as well as based on the quantities that you purchase the medication in. The delivery cost if you order online will also impact on the overall cost of the treatment.

With this in mind it can be very helpful to compare the cost of Nexium so that you can get the best price on your treatment. If you have to purchase Nexium on a regular basis it can really pay to compare prices as the difference in cost can be quite significant in some cases.

The Internet makes it very easy and quick to compare the cost of Nexium, which means that you won’t have to spend a huge amount of time trying to get prices on this medication from the variety of pharmacies. You can compare Nexium prices with ease and speed online and you will be able to see at a glance where you can find the most competitive prices on this treatment, what quantities you can buy in, what payment methods you can use, and how much you will pay for delivery of your medication.

When you compare Nexium prices online you will often find that you can save money by purchasing your tablets in larger quantities, so if you are using them regularly or there is more than one person in your household that has been directed to use Nexium it is worth considering purchasing in larger numbers. This will not only save you money on the cost of the medication itself but also means that you will not have to order your Nexium as often as you otherwise would, which means that you can also save money on the cost of postage.

Many men who are suffering from the male condition known as erectile dysfunction may be advised to take a treatment called Cialis. This is a treatment that is designed to help men who have Cialis, enabling them to achieve and maintain an erection so that they can engage in sexual activity and having a positive knock on effect on other areas of their lives.

Men who have been advised to take Cialis in order to help them with their erectile dysfunction often turn to the Internet in order to purchase their treatment. There are many different reasons why so many men now purchase their Cialis online and some of the more common reasons for doing this include:

• Being able to purchase Cialis from one of a number of reputable online pharmacists that are able to offer this treatment at great prices and in the quantities that you prefer to buy in
• Being able to avoid embarrassment. Whilst having ED is nothing to feel ashamed of, as it is something that many men are affected by, men who have to go out and purchase medication for the treatment of ED may feel embarrassed and self conscious. When you purchase your Cialis you will not have to worry about walking into a bricks and mortar pharmacy and having to wait for your treatment to be dispensed in front of other customers and staff
• Being able to save a lot of time and hassle. By ordering Cialis online many men are able to save themselves a lot of time and inconvenience, as they can browse the different deals on this treatment and place their order at any time to suit them and from the comfort and privacy of their own homes. They can also then benefit from speedy delivery to their home
• Being able to compare deals with ease and speed. With a range of reputable online pharmacies that offer deals on Cialis, using the Internet makes it fast and easy for men to quickly compare the different deals and prices in connection to this treatment and then place their order once they have found the right deal
• The ability save money is another reason why men often turn to the Internet to buy their Cialis. You will find a number of different prices, which can vary based on factors such as the pharmacy you buy from and the quantity that you buy amongst other things. You may also find that it is cheaper to buy from online pharmacies due to the lower costs that they incur, which are then passed on to the customer

Binge Eating! Is their a cure?

I’ve answered this question a lot lately and the answer is “YES!” Which is why I am uncovering “three surefire binge eating treatments!…”

What is a Eating Binge- It’s a dependency for food when in the need of comfort. “Don’t feel well? Then you want food.” “Lacking confidence? Then you turn to food!”

So what’s the cure- Simply put if you admit to this dependency you can start to let these treatments work for you.

3 Really Good Treatments To Control Emotional Eating….

1. Throw away the favorites! – People aren’t eating whatever. When they start to overeat. They have a comfort food in mind, and the best way to stop this immediately is to get rid of it!

*Example-”Ice Cream” Treatment- “Buy Frozen Yogurt” Start to implement small disciplines which ultimately lead to a cure!

2. Understanding Your Thoughts- What happens in your head before overeating? “For me it was the constant worrying about MONEY, I had quite bit of financial problems… BUT. Once you start to KNOW the times and thoughts that you have before a binge you can start to fight it!

3. The “Law Of Discipline”- One of the hardest laws to follow. But this is what’s so important and GREAT about this law. If you win more than you loose with this law, you’ll ultimately start to feel wonderful!”

DECISION -N- CHANGE!…. Two words that can hands down reap success and failure depending on which way you turn.

Description

Bladder cancer is frequently mistaken for a bladder infection, because the two conditions share many of the same symptoms. The presence of blood in the urine and painful urination, though, are telltale signs of bladder cancer.

Bladder cancer strikes three times as many men as women and is usually found in people over the age of 40. Approximately 40,000 new cases of it are diagnosed yearly in the United States, and more than 15,000 people die from it each year. It is commonly caused by exposure to artificial chemicals and industrial compounds.

Signs and Symptoms

Blood in the urine

Pain during urination

Appetite or weight loss

Low-grade fever

Pain in the pelvic area or lower back

Conventional Medical Treatment

If you suspect that you have bladder cancer, visit your physician immediately. Often the diagnosis is suspected because blood is detected during a routine microscopic examination of urine conducted during an annual physical exam. To confirm the diagnosis, your doctor may perform a CAT scan, or a cystoscopic examination, during which a scope is passed through the urethra into the bladder to collect a sample of the bladder lining, which is then tested for malignant cells. If bladder cancer is diagnosed early, surgery alone is usually successful in removing the growth. After surgery, the patient must be tested every 3 to 6 months for recurring masses. Approximately 70 percent of bladder surgery patients develop another small tumor within five years.

If the cancer is not diagnosed early and is allowed to penetrate the bladder wall or surrounding layer of fat, the cancer will probably require surgery followed by radiation therapy or chemotherapy. During radiation therapy, a focused beam of high-energy radiation is used to destroy cancerous cells. Radiation is targeted only at affected areas as and is performed regularly for a set period of time. During chemotherapy, the patient must take medication (usually intravenously) that is designed to kill cancer cells.

Complementary and Alternative Treatments

Traditional Chinese Medicine

Acupuncture traditional Chinese Medicine regards cancer as an energy imbalance caused by any number of factors, including poor diet, lack of exercise, stress, environmental toxins, or overwork.

Acupuncture may be used to improve the flow of energy along the bladder meridian and by targeting specific acupoints, which may offer pain relief. It also can be used to help reduce the negative side effects of radiation or chemotherapy.

Acupressure This modality works on the same principles as acupuncture, and the same meridians can be manipulated to help alleviate pain and promote overall energy balance. Herbs that strengthen the immune system may often be very beneficial.

Chinese Herbal Therapy Studies in Japan have demonstrated that fresh aloe vera juice contains chemicals that slow the growth of cancer cells and impair their ability to spread.