Personality/Anxiety/Mood Disorders

Posted by Barbara Melville

I recently completed a couple of careers articles, one on training to be a psychiatrist in the US and Canada, and another one for the UK. I usually write to an American audience but I came across a lot of research for other countries too (I also knew a fair bit about the UK process). If anyone’s interested in the requirements of another country, please get in touch. Nobody has to feel left out!

I wanted the articles to be straightforward – a no-nonsense list of requirements rather than a debate. I read a lot about careers in psychiatry. Many sites and books focussed on the rewards but failed to mention possible drawbacks (other than stressing the competition and demands that come with applying for and completing medical training). What about the risks to one’s own mental health? What about issues in the various mental health systems?

Individuals will find varying rewards and concerns in their careers – this can be said of any job. It’s also quite difficult to measure human qualities. The Royal College of Psychiatrists make an effort, at least. Their site offers their view of the qualities required to become a psychiatrist, and also includes questionnaires. According to their site, I’d make a good psychiatrist. But in my head and in my heart, I am sure it will never be the job for me.

Posted by Barbara Melville

Research into mental health is very much a progression, and so writing about it is also a progression. If all the articles were already written, there would be nothing for me to do. It is true that there are some more defined areas that haven’t been covered yet, and that will change. If you have any suggestions for areas that you’d like to see in articles, feel free to drop me an email.

I have already had some suggestions and they haven’t been forgotten about. I tend to plan articles in advance so please be patient if it takes a while for your idea to appear. It’s fine if you want to chase it up – I can probably give you a rough idea of when I can work on it. The articles are short, around 600 words, but sometimes even the shortest of articles require several hours, sometimes days, of work.

Upcoming articles will likely cover the following:

• Criticisms of the DSM-IV-TR
• Neurosurgery for mental disorder
• Obsessive-compulsive spectrum disorders
• SSRI withdrawal syndrome
• Abuse in the mental health system
• The terms used in mental health
• Treatment for borderline personality disorder

Other subjects may sneak ahead if I’m waiting for data. For example, I’m awaiting specific information on SSRI withdrawal syndrome (and have been for a while). I get the feeling Christmas will happen first.

Posted by Barbara Melville

I decided an article on the DSM-IV-TR was long overdue. DSM-IV-TR stands for the Diagnostic and Statistical Manual of Mental Disorders fourth edition text revision (you can take a breath now). Published by the American Psychiatric Association, it is the standard handbook used by mental health professionals in the United States, listing mental disorders and descriptive diagnostic criteria. The DSM-V planning is underway and the full revision is due to be published in 2012.

The DSM-IV-TR informs several of my articles and I felt it I should write an overview article for those who are unfamiliar. However, I don’t think it’s enough. This is why I’ve decided to write a second article to look into, perhaps discuss, some of the praises and criticisms of this manual. The controversy of mental health never sleeps. I, however, do sleep and so I can’t stop and explain every controversial term or topic every time I come across one. I can only explore them in new articles.

I don’t hold a largely negative view of the DSM-IV-TR. I think it is a useful guide and at present I can only envisage improvements, not alternatives. My main criticism is that it doesn’t cite references, which I think is poor (even if they do publish sourcebooks). If I use a book that boasts a strong evidence base, I expect them to back it up within those pages. The expertise surrounding the consultation and production of these manuals is not a swaying factor for me – expertise and evidence are not synonymous.

Posted by Barbara Melville

I’m still alive, though my shoulder has been giving me a lot of bother, slowing down the writing process somewhat. Those awaiting the questionnaires on OC spectrum disorders shouldn’t be waiting too much longer – I’ll get them emailed out tonight or tomorrow. Also, as an update for regular readers, I’ve had no emails back regarding a) dark therapy and pregnancy and b) propranolol and blunting memories. I’ll send out a few gentle prods this week. There are also a few organizations I didn’t contact the first time round.

I’m also awaiting the arrival of books on the etiology of obsessive-compulsive disorder and also neurosurgery for mental disorder. They’re interesting areas and they haven’t been forgotten about. Unfortunately, I’ve had to dig a lot deeper then I’d like – many online sources on OCD are contradictory. I come across so much incongruous material. Sometimes I want to pick up the World Wide Web and give it a good shake.

Friends often suggest that I use the local library. The libraries in my home city are quite poor for my purpose. Fortunately, it turns out I can re-join my university library as an external member (for a small fee). They have mental health nursing and practice programmes, and so consequently stock a number of useful books and periodicals. It will make research much, much easier.

Posted by Barbara Melville

An editor friend suggested that I use a few case examples in my articles. By this, she meant conducting my own interviews to get personal perspectives, rather than regurgitating individual case studies published in journals (though such studies definitely have their place). I felt alarmed at first – I like to write cold, factual pieces. On reflection, I decided that this is a good idea, though I think it’s imperative that the point of such articles are crystal clear. There should be no doubt in the reader’s mind that they are viewing an individual perspective.

I spoke to a friend about their depression last week. She described how small but upsetting events from her past, such as arguments or embarrassing moments, frequently pop into her head when she’s feeling low, causing her great distress. If this is a symptom of her depression (and keep in mind that it might not be) then it is quite specific. I don’t think I’ve seen it mentioned on any symptoms list, but in my mental health nursing practice, I heard similar concerns described by people with major depression and PMDD.

What would be the point of relating that experience in an article? Well, for some, it will help them piece together some idea of what mental disorder might be like. It gives some meaning to symptoms such as “depressed mood”, which, without examples, may leave people confused. Also, if presented clearly, it highlights how an illness such as depression can affect people differently. Anyway, this week I’m working on a questionnaire for people with obsessive-compulsive disorder, which I will then try to work into articles. We’ll see how it goes.

Posted by Barbara Melville

I’m working on a few articles at once, hence my apparent disappearance. I had originally set out to write a piece on neurosurgery for OCD. Since neurosurgery can be used for other disorders such as depression, I felt it made sense to expand the article to include this information. Then I wanted to add more. And more and more. After viewing all the research I’d gathered, I realized it would be too difficult to cover it adequately in the space of ten articles, never mind one. Now I know why my mother used to preach about the importance of word count in my early school essays. “There are times when it’s important to be able to condense,” she’d say. I didn’t listen, of course. I thought condensing had something to do with milk.

More recently, she was asking about the importance of writers having a thick skin. I think it’s very useful. However, there are always buttons, and dealing with inconsistencies in sources is mine. Yes, this again. I find it very irritating – it frequently affects my research. For example, there are many reputable mental health organizations that provide information for the public. Unfortunately, this information is sometimes out of date (and in some cases, completely incorrect). It is supposed to be accessible and it’s rather concerning when there are glaring inaccuracies and/or ambiguities. Mental health is an area that is already rife with misconceptions. More on this soon...

Posted by Barbara Melville

I’ve had a lot of feedback on this subject, from both professionals and people with PTSD. This morning, I received an email from someone describing how they had experienced relief of their PTSD symptoms but had been unsure as to why. Many years later, they heard about propranolol in the news, a drug they had been prescribed for a medical condition around the time their symptoms improved.

This is something I’ve wondered about – people who have a) experienced trauma and/or post traumatic stress and b) been prescribed propranolol for other reasons. I telephoned a friend who has PTSD and is taking propranolol for heart disease. She too described an improvement in symptoms since taking this drug, even though her regimen would be quite different to those used in research studies.

I do not wish to trivialise these accounts in any way, but it’s important not to jump to conclusions – there could be a number of factors attributing to why these people experienced improvements. I’ve also only had a very quick web search but it’s incredibly likely that this area has already been brought into question. I’m going to take some time over the next month to explore this in more depth.

Posted by Barbara Melville

Monoamine oxidase inhibitors (MAOIs) are powerful and effective antidepressant drugs. I agree that MAOIs are likely overlooked as an effective treatment. They’re also a victim of misinformation, with conflicting factsheets in different corners of the web. I cannot overstate how important it is to read the documentation that comes with these medications. For doctors who provide separate factsheets regarding restrictions, it is essential that these are up to date.

Anyway – misinformation. Many online mental health resources (including well-known, reputable organisations) provide different details about what can and cannot be eaten when taking MAOIs. I find this unacceptable. If I were a patient considering these drugs, I would understandably want to completely avoid the risk of interactions. I imagine such contradictions could cause unnecessary distress to those prescribed them, not to mention the fact that following the wrong diet can be very dangerous.

It’s unfair on readers if information is inaccurate. I try very hard to research thoroughly. This becomes more challenging when supposedly good sources aren’t consistent with each other. Anyway, I did find some excellent research papers in the end. I’ve also emailed some of the drug companies that make MAOIs to ask for the information leaflets and dietary restrictions that they provide for patients. Let's hope they don't contradict each other.

Posted by Barbara Melville

The boundary between sadness and depression is a topic that has inspired much debate. When a physical illness is present, depression may be seen as a realistic outcome. This can be unhelpful and stigmatising. For example, it may promote the idea that people should expect and tolerate symptoms of depression.

The main difference between sadness and depression is that depression persists and notably affects our functioning. However, this is quite a general definition. Researchers sometimes use different definitions and measurement scales, which calls their results into question. Which scale is the right one? Which definition is correct? Where do we draw the line? Are there other factors to consider?

I think communication can be a huge factor when considering health complaints. I make no secret of the fact I have chronic pain, and I definitely make no secret about how abysmal the communication has been. Different professionals lobbied contradictory pain management models, insisting that I’d be harming myself if I took advice elsewhere. This lack of consistency was much more stressful than any symptoms.

That is, however, my personal experience, which may or may not be similar to the experiences of others. Fortunately, I have not had depression alongside my pain condition, and I think this is partly because I have supportive friends and family that I can talk to. I’d never underestimate the importance of such support.

Posted by Barbara Melville

When I was researching lithium and pregnancy, it quickly became apparent that alternatives really need to be investigated. Bipolar disorder is one of the mood disorders that responds well to lithium treatment, and most women with bipolar disorder are in their childbearing years. Since both continuing lithium and stopping lithium present risks, potential mothers may have some difficult choices to make.

What about alternative drugs? Other mood stabilizers pose similar risks and so are unlikely to be prescribed to someone who functions well on lithium. There are some other medications, such as certain types of antidepressants and antipsychotics, which may be safer in pregnancy than lithium. However, many may have already tried such drugs, without success.

Lithium and breastfeeding is also an area of controversy, with most sources advising against it. However, although we do know it’s passed into the breast milk, there has been no research into the full implications of lithium and nursing. We do know that serious illness relapse is a likely implication of not recommencing lithium shortly after the birth. Possibly another tough choice for mothers-to-be.

I wonder if Dark Therapy may be a suitable intervention for pregnant women. I’m stabbing in the dark here (no pun intended) as I really have no idea if such a treatment would pose risks to pregnancy. I imagine that amber glasses (that is, glasses that block out blue spectrum light) are likely to be a safe self-help option, possibly as part of a holistic, bigger picture. I’ll see if I can find out some more…