Monday, February 26, 2007

Virtual Reality: Can it Aid in the Fight Against PTSD?

In one of my previous posts, I discussed the serious issue of Post Traumatic Stress Disorder and the detrimental effects it has on American troops who had served in Iraq. Now, thanks to technology and to research lead by Dr. Albert “Skip” Rizzo (pictured to the left) of the University of Southern California, a new method of treatment may make it possible for soldiers, who were exposed to traumatic episodes, to overcome the terrible affections of this dreadful disease. This advanced form of “exposure therapy” involves the use of virtual reality, in a safe and controlled setting, to simulate intense, harsh, lifelike events that a soldier must repeatedly be exposed to in order to confront and ultimately gain control over the overwhelming fears and anguish associated with any particular traumatic event. Even though the trials on this distinct therapy are in its infancy, the results look promising so, naturally, with all the excitement surrounding this brand new form of treatment, I decided, once more, to seek out other reputable blogs to engage in the dialogue. My first comment can be found here at Mind Hacks, an excellent, informative, and popular blog dedicated to the fields of Psychology and Neuroscience. My second post can be found here at A Soldier’s Mind, a passionate blog committed to the men and women in the armed forces serving in Iraq. Both comments can also be seen below:

What an exceptional idea to treat PTSD. However, I am bit surprised it had not been thought of sooner, considering that we have had much of the technology for years and, as you already mentioned, it is unequivocally safer than exposure to any form, including the lowest level, of combat conditions. One of the reasons I believe that this treatment may be more beneficial than traditional imaginative therapy to a soldier suffering from PTSD, is due to the extensive amount of detail involved in creating this “Virtual Iraq.” In case your readers didn’t know, the realism factor of this program is truly astounding. It includes a fully rendered three-dimensional environment with impressive graphics (pictured below) and sound; powerful subwoofers are placed under the soldier’s chair to create movements and vibrations (pictured to the right); and a system allows for odors to be dispersed which include: gunpowder, cordite, burning rubber, burning smoke, diesel fuel, Iraqi spices, barbecued lamb and body odor. As you can probably tell, I am very excited about the possibilities of this new treatment. Hopefully this technology can help alleviate the distress of our affected soldiers.

Thank you for shedding light on what is becoming Iraq’s silent wound: Post Traumatic Stress Disorder. This is a very serious issue and needs to be better understood because unfortunately, more and more American troops are coming home from Iraq having experienced severely traumatic events and are at risk for developing PTSD. As someone who has witnessed, first hand, what PTSD can do to an individual, I am greatly pleased to see a push towards treating this terrible illness. The virtual reality concept is fascinating because the idea is to expose patients to scenarios that trigger their PTSD and work through them with the goal of lessoning the negative side effects. After reading your post on the workings of this program, and of some the preliminary findings, I must say that I am very hopeful about the tremendous possibilities that this new form of exposure therapy may have on soldiers suffering from PTSD.

Wednesday, February 21, 2007

Teenage Suicide Rates: What is Causing it to Increase?

Over the past decade in the United States youth suicide rates have steadily been declining. Most of this is credited to increased education; more outreach programs, better support systems, as well as more individuals accessing treatments, including prescription drugs, for psychological problems like depression. However, according to the Center for Disease Control and Prevention's Annual Summary of Vital Statistics published last month, the suicide rates sharply rose more than eighteen percent in youths from the ages of one to nineteen years old: from 2.2 per 100,000 in 2003, to 2.6 per 100,000 in 2004, and from 1,737 total suicide deaths in 2003 to 1,985 in 2004. Specifically in those youths from the ages of fifteen to nineteen, the figures reflected more than a twelve percent increase in suicide, from 7.3 per 100,000 in 2003 to 8.2 per 100,000 in 2004. Curiously the rise coincided with the inception of the Food and Drug Administration’s mandated heightened warnings, on the labels of selective serotonin reuptake inhibitors, or SSRIs, a particular kind of antidepressant medication that includes Prozac, Paxil and Zoloft. These “black box” warnings, as they are better known, were added in March 2004 over growing concerns that the drugs led to an increase in suicidal thinking in patients. The prescribing of these medications to children subsequently dropped by over twenty percent.

Since it is well documented that black box warnings can indeed deter some patients from taking certain medication, some mental health professionals are openly criticizing the FDA’s decision to place them on SSRIs. "Patients will be frightened off appropriate treatment," stated Dr. Alex Vuckovic, medical director of The Pavilion at McLean Hospital in Belmont, Massachusetts. "It's already happening to child psychiatrists and their patients. These drugs save lives—end of story, no ambiguity." The nonprofit group Mental Health America has also called for a further look into the FDA's decision to strengthen warnings on SSRIs. "As a result of the agency's activities, dramatic decreases in the use of SSRIs in the adolescent population were noted," said David Shern, president of Mental Health America in a statement issued on February 5th. "Other research has indicated a general relationship between the use of SSRIs and decreasing suicide rates in the general population. We must therefore wonder if the FDA's actions and the subsequent decrease in access to these antidepressants have caused an increase in youth suicide." He added, “This is a disturbing reversal of progress.”

Although there does appear to be a correlative relationship between an increase in youth suicide rates and the reduction of SSRI prescriptions, due to black box warnings, I find it a bit impulsive and irresponsible on the part of critics who hastily point the finger of blame at the FDA. I wholeheartedly agree that the trend is alarming and quite unsettling; however the problem with examining such an immense subject like national youth suicide rates and the explanations of any increase is that it is extremely complicated and difficult, since there are almost an infinite amount of unknown variables that may have an influence on behavior. How can we be sure which one is responsible? Without any solid empirical study examining causative factors in this increase, one simply cannot make factually-based claims, as did Dr. Charles Nemeroff, chairman of the department of psychiatry and behavioral sciences at the Emory University School of Medicine, who bluntly said “I have no doubt that there is such a relationship.” That is a bold and unsupported statement that many other scientists completely disagree with. It would be unwise to forget one of the most fundamental principles of good scientific research: correlation is not causation. We must get to the bottom of this tragedy but we can not be so quick as to rush to any conclusion that may possibly alter and have lingering effects on public policy, research and/or treatment decisions, without sufficient data. In the meanwhile we must continue to support existing programs and further educate ourselves and our children about the seriousness of this issue and remain ever so vigilant to any potential problems that may arise and act upon them as soon as possible.

Monday, February 12, 2007

Diagnosis and Treatment for Young Children: How Accurate and Safe are They?

Over the weekend I came across a truly heartbreaking story about a child named Rebecca Riley. Rebecca, pictured to the left, was only two and a half years old when she was diagnosed with both attention deficit hyperactivity disorder and bipolar disorder. She was then put on the powerful drug, Clonidine, by her psychiatrist, Dr. Kayoko Kifuji. But instead of helping her, the drug slowly destroyed her internal organs, filled her lungs with fluid, and she eventually died. Now her parents, pictured below, are being charged with first-degree murder. Prosecutors say they killed their daughter by regularly giving her drug overdoses, ostensibly to keep her calm and to get her to sleep. As disturbing as the actions of the parents are, I was also equally appalled by the diagnosis and treatment recommended by this psychiatrist. What could have possibly prompted her to diagnose such a young child with such a severe mental disorder without sufficient existing medical research on the matter? How common is this practice? This week, I decided to join the dialogue, regarding this controversial issue, by seeking out reputable blogs on the subject and expressing my opinion.

These are some of the comments I made:

(The Trouble With Spikol)

What a tragic story. Obviously, whether negligent or intentional, these deplorable, unstable, so-called parents are to blame for the death of this innocent child. I am deeply disturbed by their reckless and reprehensible behavior. However, I am almost as equally disturbed with the psychiatrist’s astonishing diagnosis of not just one, but two serious mental disorders in reference to child of less than two and half years of age! To arrive at such a diagnosis, for such an early and crucial period of development, with very limited scientific data known, accompanied with the potential risks of extremely powerful psychotropic drugs, is simply irresponsible and dangerous. Clearly there needs to be much more oversight in the cases of these very young children because this is merely another example in what is becoming an alarming trend of younger and younger children being treated for mental disorders with these highly potent and potentially harmful drugs.

(Furious Seasons)

I do not understand how such a tragedy was allowed to take place. Clearly the parents in this story are most culpable for the death of this innocent child, but the blame also partially rests on the presumptuous deeds of this negligent psychiatrist. Rebecca Riley was only two and a half years old when she was diagnosed with such a serious adult mental disorder. That diagnosis was completely irresponsible, in fact I believe it was borderline unethical because there is simply not enough empirical research on how to properly, if possible, diagnose such young children, let alone on how to decide on how much potentially dangerous psychotropic medication they should be on. There is currently a disturbing trend taking place of many children under the age of six being treated in this same exact manner. This is plainly wrong. How many more tragic stories will it take before more oversight and clearer guidelines, for the treatment of our children, are implemented?

Monday, February 5, 2007

The Mentally Disabled: Why those Watching Over them Ought to be Watched

There is a new disturbing realization emerging from our mental health care facilities regarding the safety of our nation's mentally ill and handicapped. They are among society's most vulnerable individuals and many of the people entrusted to watch over them are not doing their jobs. Many of the mentally disabled have been subjected to extreme cases of neglect as well as to unimaginable acts of abuse at the hands of their own caregivers. Sadly, most of these helpless individuals can not fend for themselves nor can they seek out the proper help needed because of severely limited mental capabilities. Unfortunately, many of these victims have no choice but to suffer in silence. This is all very shocking news but what is even more alarming is that this problem is much more rampant than had originally been thought.

Last week, police arrested Patrick Solis, 22, on suspicion of false imprisonment and dependant abuse while working as a caregiver at Jossen Vocational Academy in Anaheim. Solis was employed at the facility for at least five months before a cellular phone surfaced that contained videos police said reveal him beating and taunting two innocent developmentally disabled men. "They're like little children who can't protect themselves," Anaheim police Detective Cherie Hill said. “The men seen slapped and taunted in the video are both 38 but have the mental capacity of two-year-olds, and the suspect on the video targeted the most vulnerable of victims: two men who can barely talk. One only knows how to say 'Mama' and the sign language sign for bathroom.” This grainy cell phone picture of the incident, located above, shows the helpless men cowering, frightened, whimpering and crying. At one point, someone is heard clapping. Another is slapped and beckoned to come closer, only to be slapped again. The full video can be seen here. "What else happened that wasn't taped?" Anaheim police Sergeant Rick Martinez asked. "Nobody would've ever known had it not been for that video."

In another incident, Monique Marie Tetter, 25, pictured to the right, a caretaker working for The Department for Mental Health and Mental Retardation in Kentucky, pleaded not guilty last week for allegedly leaving Michelle Miller, a severely mentally disabled woman under her care, alone for at least ninety minutes. Police were called to an apartment on Thursday afternoon after a building employee spraying for insects found Miller, lying inside the door of Tetter's living room with a plastic bag over her head. "Thank God for that maintenance man," Roy Miller, the father of Michelle Miller, said. "You cannot leave her alone."

Just last May, in a highly publicized report from the Justice Department, dozens of group homes and caregivers from the Washington D.C. area were investigated for their roles in abuse and neglect of physically and mentally disabled residents, which resulted in fourteen "preventable and questionable" deaths since January 2003. Many of the residents were starved to death including Matthew 43, and Emily 60, who at the time of their deaths weighed less than fifty pounds. Other deaths resulted from intentional scalding with hot water, anemia, gangrene of the stomach, organ failure, and septic shock due to untreated illnesses. Many of the surviving mentally disabled residents of the group homes were beaten, berated, sexually accosted, neglected or targeted for theft, Justice lawyers noted. "These are human beings, just like anybody else, who just need a little extra attention and help from the District of Columbia," said council member Adrian M. Fenty, who heads the council's Committee on Human Services and has been working on the issue. "And they didn't get it. And it cost them their lives."

As a society we have a moral obligation to protect those who are less capable and to punish the culpable. Currently, the lack of adequate oversight, faulty state-licensed care facility policies, unqualified staff, lenient laws, and poor pay for our aides are causing us to fail in that obligation. The majority of the caregivers in the U.S. today are admirable professionals who work very diligently to care for the nation's mentally disabled. However, many are not quite as noble, such as Patrick Solis, pictured to the left. Thus it falls upon the rest of us to demand reform of the laws that govern many of the failing policies that permit these atrocities. For those who have died, and for those who still need our help, we must do better.

In order to report cases of abuse please contact the local law enforcement agencies or the California District Attorney's Association or the Office of the Attorney General.