I did my practicum for my psych degree when it was called Northwestern Institute. They had units there for teens who were adopted, a women's unit run by psychiatrist Louisa Lance, and also one for multiple personality disorder. Patients would get out of control and were captured in butterfly nets. That's how I learned I never wanted to work in a psych hospital.
"Any smokers here?" asked Bill.
No one in the audience smoked.
Smoking is the leading cause of preventable death in the US, said Bill. He and his siblings were raised by a single mom who was a constant smoker, esp. in the car with the windows rolled up, "so naturally," he said, "we all became smokers."
He remembers driving with her in their '58 Chevy inhaling all that second-hand smoke.
I can identify, Bill. Ours was a Ford Country Squire, license plate HG 91.
My own father died of smoking - 4 packs a day - at the age of 59. He finally quit at age 42 when he couldn't stop coughing.
No thanks, Doc.
On the other had, it'll make me look cool.
Smoking has declined 50 percent in the last decades. But not necessarily with mental health consumers, said Bill, who underestimate its dangers and believe they get a therapeutic benefit! They say it relaxes them or makes them think clearer, but in reality what they're doing is relieving anxiety from the nicotine w/drawl.
There are nicotine receptors in the brain for this powerful drug. B/c of smokers' increased morbidity rate and low quit-rate, mental health consumers die an average of 20-25 years sooner than the average person. They also die from other causes such as diabetes, caused by many meds (including my antirejection meds which gave me insulin-dependent diabetes) and obesity, which affects the cardiovascular system.
The best way to stop smoking, said Bill, is to join a peer recovery group, which he and Sharon are in the process of forming at her office. He was trained in the field of smoking-cessation.
Collaborative Care in Abington, PA, a two-story house turned into a wellness center.
One way to quit is thru medical intervention:
The Nicotine Patch
Nicotine Gum
Meds such as Zyban (Wellbutrin) or Chantix
Wiring your jaws shut and feeding you intravenously
Smoking is the fastest way to deliver drugs to your brain, faster than the needle.
I didn't know dat, did you?
That's why crack-cocaine was such a big hit a decade ago.
For mental health consumers on a fixed income, they spend 1/3 to 1/2 of their income on cigarettes.
The social hazards of smoking are relatively new.
While smoking was once considered 'cool,' today people are often ostracized for smoking. It's difficult to get a job if you smoke and difficult to get a relationship going. People are no longer tolerant about smoking.
Smokers must go outside to smoke.
Indeed, Fred down the street, a 50-ish gentleman, must step outside to smoke. Today it was raining so he stood there between the screen door and the door just puffing away.
He must not think too well of himself.
Executive Director, Psychiatric Nurse Practitioner
of Collaborative Care.
We're in a new age of treating the person, not necessarily the illness, said Sharon.
New testing has been developed to determine what meds work for you and in doing so, a diagnosis becomes apparent.
In other words if lithium would work for you, you no doubt have bipolar d/o.
Quite simply, you spit into a tube and a saliva assay - or "an investigative (analytic) procedure in laboratory medicine, pharmacology, environmental biology, and molecular biology for qualitatively assessing.... from Wiki - is sent to a lab to be tested.
Sharon uses the company Geomind, which is not covered by all insurers yet. It's covered by IBC and Aetna, but not Medicare or Medicaid. Geomind is in Chalfont, PA.
One of Sharon's patients, with bipolar d/o, was sitting in with us. He'd had the test and told me they were working on his meds.
Folks with bipolar d/o and schizophrenia, said Sharon, are the hardest to prescribe for.
Drugs are metabolized in your liver, your brain or in your cells. One man said he'd been tested by another company - for $3,500 - and told his body is a fast metabolizer, so most meds don't work for him. He's been on..... 19.
Sharon passed out several handouts including one which I'll quote to show you the incredible complexity of this brain of ours:
Genes - Gated calcium channel - CACNA1C
Role - Regulates entry of calcium into cell
Clinical connection - Mood stabilizers target excitatory neurotransmitters
These tests can determine if you're on too many meds or if your dosage is incorrect. "I don't want to hurt you," said Sharon. "I want to heal you."
The test is useful for certain categories of individuals, including those with autism, a very hard neurodevelopmental condition to treat.
Sharon has done intakes on 20 patients for the assay test. She does a complete psychiatric evaluation and shares this info with the testing company. Included in her eval are physical problems and other meds the patient takes.
"I wanna make sure I'm not overdosing them." She faxes the results to the company. They ask what changes she can make to the meds.
Genomind has a patient assistance program for patients w/financial need or w/o insurance.
But it doesn't test for all the traits, such as brand name of drug vs generic. She discussed the Wellbutrin generic, which was found to be ineffective, but said the generic company fixed the problem.
When ZOLOFT is prescribed for OCD, 100 mg or more must be used, as it's ineffective on lower doses.
Asian women, she notes, have different neural pathways. We had one Chinese woman in attendance whose family owns a great Chinese restaurant.
BENZOS, which should calm a person down, act instead to make the Asian person hyper. She also has a blockage (inability to absorb the drug) for Lexapro, a popular antidepressant. Sharon called the testing company and they discussed what med to put her on for her depression and anxiety.
Sharon said Dr Scott Fleischer also does the genetics testing. Fleischer is on our Top Docs list.
ALTERNATIVES TO MEDS
Some vitamins or supplements enhance the effects of psych meds.
Did you know that FOLIC ACID is the precursor of all serotonergic drugs? Serotonin grows out of it. The prescription drug DEPLIN is 7.5 mgs of folic acid.
METHYLFOLATE is:
the natural, active form of folic acid used at the cellular level for DNA reproduction, the cysteine cycle and the regulation of homocysteine among other functions. The un-methylated form, folic acid (vitamin B9), is a synthetic form of folate found in nutritional supplements.
Ahem! Now that we've made this clear, we must understand that:
10% of the general population (homozygous TT) lack the enzymes needed to receive any benefit from folic acid.[citation needed] Another 40% of the population (heterozygous CT) appear to convert only a limited amount of folic acid into levomefolic acid.This is precisely why the DNA test is important.
Her Geomind company says to encourage people to take MELATONIN to help them sleep and also take SAM-E.
Oh, sorry, that's Sammy Davis, Jr.
Vitamins and supplements one may use include Vitamin-D Complex (I dunno why they should have a complex, unless they're comparing themselves with the Sun.)
People should be tested to see if they're low in vitamin D.
Someone asked a question about LEXAPRO. Sharon said the proper dose of Lex is up to 30 mg. More than that will not help. She suggests Lexapro plus exercise and vitamins.
Plus Psychotherapy, which changes the neuroplasticity of the brain.
A parent asked if illicit drugs can cause bipolar d/o?
Not cocaine or LSD or marijuana, said Sharon. Smoking pot is an anxiolytic, relaxing a person.
A 62-yo woman named Gloria, diagnosed with bipolar, wondered if she would get schizophrenia, like her 65-yo sister has. Gloria's mom, who died at 75 of pancreatic cancer she told me, had bipolar d/o.
No, you won't, said Sharon. She's too old.
Shelly Quigley, wife of speaker Bill, and a retired social worker, has a brother w/schizophrenia. Read my entertaining blog post about Willie, who was a very strange child.
Tonite's Channel 12 movie?
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