Dutch Psychiatric Patients Likely to Be Victims of Violence

Ten to 24 percent of Dutch people with a psychiatric diagnosis have been victims of verbal, physical or sexual assault in the past year. This is more than the percentage of violence victims in the general population. Dutch researchers published these results in the journal Mgv. I do not have access to this journal, so I can’t read the orignal paper.

According to a news report on the publication, there is very little research in the area of violence against psychiatric patients. Most research focuses on patients as offenders rather than as victims. This is somewhat understandable, given the public conception of psychiatric patients as dangerous people. But it is very stigmatizing and potentially detrimental.

People with schizophrenia and other serious mental illnesses which cause visible symptoms, were the most likely to be victimized. This calls for further research into the prevalence and nature of these actions and ways we can protect people who are vulnerable from violence. And please don’t tell me that people with visible symptoms probably elicited the violence, since this is no excuse.

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Announcement: New Forum for Trauma Survivors and People with Serious Mental Illness

I have set up a new support forum for survivors of trauma and abuse and people with borderline personality disorder, dissociative identity disorder, PTSD and related conditions. In order to join, you don’t need to be both a trauma survivor and have BPD or something similar – it’s okay if you fall into just one of these categories. For now, members need to activated by me before being able to participate. This is to prevent trolls and spammers from using the forum, so don’t worry about not being allowed on the boards. Go to the forums and enjoy.

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Blog Carnival of Mental Health: Diagnosis

Welcome to the first Blog Carnival of Mental Health. I’m a day late, but I’m going to share with you an interesting if small collection of posts. I must say that it’s rather ironic that I’m hosting a carnival on the theme of diagnosis barely a week after receiving a new diagnosis myself. Anyway, enjoy!

First, K at Feminists with Female Sexual dysfunction writes In Defense of Dysfunction.

Next we have Meredith on Things fall apart (& get putr back together). She writes Diagnosis: the big secret.

CBTish wrote two relevant posts: Edges and Values.

Miss_Invisible wrote Having a Mental Illness is Not the Same as Having a Diagnosis.

Mike of Unhappy Happiness wrote Is Social Anxiety Real?

Lastly, DifferentlySane wrote Diagnosis: A Verdict Without a Trial.

The next Blog Carnival of Mental Health will be hosted by CBTish. I haven’t yet received a theme, but will let you know as soon as I find out.

ETA: CBTish E-mailed me to let me know the theme for the December blog carnival will be “night”.

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Announcement: The First Blog Carnival of Mental Health

This month, I will be hosting the first Blog Carnival of Mental Health. The theme for this month’s carnival will be diagnosis. Interpret it broadly. When were you diagnosed with a mental illness? What is your diagnosis? What do you want to change about your diagnosis, if anything? If you are a mental health professional, how do you diagnose clients? What is the most stigmatized diagnosis, in your opinion? The list of possibilities is almost endless. The deadline for submissions will be November 27. I will post the carnival on November 30. Submit posts in a comment on this post.

Also, I am still looking for hosts for the Blog Carnival of Mental Health. Slots are open from February, 2011 onwards. If you want to host, you can leave a comment here, too. Please let me know where you blog and what month you would like to host. For clarity’s sake, LiveJournal and Dreamwidth blogs are welcome to submit posts as well as to host.

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PTSD in People with Intellectual Disabilities

When searching for studies on post-traumatic symptoms, I came across an interesting paper on PTSD among individuals with an intellectual disability (ID. This study is the first systematic review of prevalence, assessment and treatment of PTSD in people with ID.

There are several reasons why people with intellectual disabilities are more susceptible to PTSD than the general population. Firstly, they are more likely to experience traumatic events, such as sexual or physical abuse. They are also more likely to experience negative life events, such as serious illness or injury. Secondly, higher intelligence is associated with better ability to avoid traumatization and to cope with its consequences. Therefore, people with ID may have a lower threshold for PTSD. Thirdly, people with ID are more likely to experience early separations from primary caregivers, hence putting them even more at risk of traumatization. Lastly, the recognition of oneself as disabled may be traumatizing to some individuals. For these reasons, there is an elevated rate of PTSD among people with ID. The literature review found four articles discussing prevalence of PTSD among those with ID. However, all studies were conducted on people referred for treatment who had gone through at least one traumatic event. Studies based on a large, heterogenous sample were lacking. Prevalence rates of PTSD varied from 5% – the prevalence among the general population -, to 60%.

Assessment of PTSD is difficult among individuals with ID, because these people tend to display different symptoms from people with normal intelligence. The Diagnostic Manual-Intellectual Disability (DM-ID, 2007), which is an adaptation of the DSM for assessing individuals with ID, has adapted PTSD criteria for people with mild to moderate ID on the one hand and severe or profound ID on the other. There are also some good instruments for measuring anxiety among people with ID, but these are not specific for PTSD.

The assessment of the traumatic event itself poses problems, as caregivers are not generally aware of a person’s trauma history or may not recognize traumatic events. Furthermore, what may not be traumatic to the average person – for example, a move arranged by others -, may be traumatic to someone with an intellectual disability.

Several treatments are recommended for PTSD in individuals with ID, but the evidence base is small. Firstly, a thorough medical evaluation is recommended, because of the high comorbidity with medical disorders. Psychopharmacology is discussed, but specific research on medication intervention for this population, is absent.

The second treatment approach focuses on changing the environment to eliminate frightening cues. Training and support of caregivers to teach them appropriate responses to PTSD symptoms, is also mentioned. This is particularly relevant for those with lower levels of intelligence.

Lastly, psychotherapy can be useful for the treatment of PTSD. There is clinical support for the use of cognitive-behavioral therapy (CBT) in people with mild ID. The techniques reported on were exposure therapy and imaginary rehearsal therapy. Two case reports were also found on the use of EMDR for PTSD among individuals with mild ID. In all therapeutic approaches described, modifications were made for the clients’ disabilities.

Reference

Mevissen L., De Jongh A. (2010), PTSD and Its Treatment in People with Intellectual Disabilities: A Review of the Literature. Clinical Psychology Review, 30(3):308-316. DOI: 10.1016/j.cpr.2009.12.005.

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Blog Carnival of Mental Health, Anyone?

It never ceases to amaze me how many active and beautiful mental health blogs are around. That got me thinking already a while ago about a blog carnival of mental health (or mental illness if you want). A blog carnival takes the following:

• An organizer. Being that it’s my idea, I would love to take that job upon me, but if anyone with a bigger blog wants to, that’s fine with me, too.
• Hosts. Every month or quarter or whatever we decide, someone will host a carnival on a specific theme.
• Participants. People will have to submit posts to the carnival that fit the theme. They don’t need to be primarily mental health bloggers, but their post needs to be about mental health.
• Readers, of course.

I was thinking about either a monthly or quarterly carnival, depending on interest. I would be willing to host the first carnival, but I need other mental health bloggers interested in taking over from me. So, if you are interested, please let me know.

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Mental Illness, Medication, and Fatigue

I have not had the energy to write much lately. The reason is not, as one might think, my mental illness. Yes, I am stressed, but I have been for months. Now, the reason that I have lower energy levels is, in fact, the medication I take for my mental health condition. A combination of 15mg Abilify, 20mg Celexa and 3mg Ativan daily seems to have turned me into a zombie sometimes.

How often are people with mental illness reprimanded for not getting out of bed, for low motivation? People in rehabilitation programs are constantly told to get back into the habit of getting up early in the morning and going to work. How many people have had their rehabilitation called a failure because they couldn’t manage to get up at 7:00 AM each morning? And how often is the person’s mental illness blamed, when in fact most psychotropic drugs – from antidepressants to antipsychotics – have sedative properties?

I am not suggesting that it is okay to push people beyond their limits when the mental illness does cause the fatigue. All I am calling for is some awareness that mental illness medications may have disabling side effects, and this needs to be taken into account both when starting the medication and when considering someone’s disability. I won’t do away with my antipsychotic anytime soon – the antidepressant is still in the trial phase, and I do want to get rid of te Ativan once the Celexa starts to work for my anxiety -, so this is not a message against medication, either. This is a simple call for consideration. People with mental illness are not lazy or uncooperative if they do not do well with standard schedules. Our mental illness might be causing us fatigue, or the very medication treatment providers are giving us for it, might.

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Autism and Pediatric Bipolar Disorder

Last Saturday, I watched the documentary America’s Medicated Kids on Dutch television. In it, one child, Hugh, appears, who has been diagnosed with a host of disorders, among which Asperger’s Syndrome and bipolar disorder. At the end of the film, filmmaker Louis Theroux questions Hugh’s mother as to Hugh’s diagnoses. He clearly sees soe Asperger’s, but what about the rest? Then his Mom replies that this is the fully medicated Hugh – on Seroquel for bipolar, among others -, and that she would medicate him for Asperger’s if she could.

The whole piece about Hugh got me thinking about the potential overlap between autism and childhood bipolar disorder. You know, childhood bipolar disorder, which is a controversial diagnosis, is not generally characterized by clear mood episodes, but more by mood swings. Hugh was diagnosed with bipolar after he made suicidal threats at age seven. I remember vividly making similar threats, maybe at a slightly older age. Was this an indication of emotional disturbance? Obviously. But did it indicate bipolar disorder? Well, I don’t have bipolar disorder now, so I probably didn’t have it as a child.

Emotion regularion problems are very common among autistics, and they need to be recognized as consequences of the autism. I am not saying that no child with autism can also have bipolar disorder, but I am saying that the confusion created by autism can look like childhood bipolar.

Are there implications for treatment? Possibly. Several atypical antipsychotics have been approved for autistic irritability, so they would’ve been prescribed whether the child was diagnosed with bipolar or not. Is this a problem? I’m not sure. I take antipsychotics for irritability, so I cannot say it is a problem per se. However, what is a problem, is when the mood swings are not tracked down to their function because they are assumed to be bipolar mood swings rather than autistic irritability. In autism, emotion dysreegulation is a response to environmental stimuli, and medication alone will not help these children (or adults) modulate their emotions. Environmental adaptations as well as coping skills, need to be found, too.

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“Exercise for Mental Health!”

Today, I swallowed my first antidepressant tablet ever, and I feel guilty. I currently read a Dutch book on antidepressants, in which psychiatrist Bram Bakker, among others, states his point of view. His opinion is that a stepped-care approach to depression means that people should first be steered towards exercise rather than antidepressants. Now I happen to take my antidepressant for anxiety, but I am well aware that exercise works for that, too.,/p>

I am not fit, and I am rather sedentary. I used to take daily walks on institution grounds, but I don’t anymore. I went to fitness class once and was overloaded even though a nurse accompanied me. Does this mean that I call for my own mental health problems?

Bakker forgets the barriers to exercise that some people encounter. Due to the construction going on, I cannot take walks on grounds unaccompanied anymore. I cannot navigate the busy gym during fitness class. If I want to bike, I need to go on a tandem. I cannot participate in my institution’s running therapy program. None of this is due to anxiety. All of it is due to my disabilities, and the barriers to access that stand in the way.

Bakker caters his running therapy mantra to depressed but otherwise healthy people. There are many reasons why people with disabilities or chronic illnesses who happen to be depressed, are unable to participate in running therapy and other exercise programs. The “exercise for mental health” mantra is a slap in the face of these people. I know. Will anyone now remove the barriers to exercise that I encounter, so that I can relieve my anxiety without having to take antidepressants?

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How (Not) to Prevent Suicide

Today, September 10, is World Suicide Prevention Day. I struggle with this day. Since, you know, well, I was suicidal. Back in 2007 and early 2008, I had suicidal thoughts. I was not depressed – I was screened for that too many times to count. My diagnosis was adjustment disorder, which has very stigmatizing criteria. Medication wouldn’t help me, since I wasn’t depressed. The ward I was committed to, didn’t have a psychologist. I was there to wait and see if my thoughts would go away on their own. In the long term – in, like, well, three years or more, it appears -, a suitable living placement would seemingly heal all my problems. But for now, all I could do was wait at the locked ward for my suicidal thoughts to subside.

I was deemed a danger to myself, because not only did I express suicidal thoughts, I was a wanderer. I could be hit by a car, willingly or not. In retrospect, I think my lack of privileges lasted far too long in proportion to the risk I actually posed. I do not know how I would carry out a successful suicide attempt. But the fact that I expressed these thoughts, was enough for off-ward-under-supervision-only privileges. It played a part in the time-out policy, which was used more to scare me than to actually seclude me. In the end, I stopped expressing suicidal thoughts, and the thoughts themselves lessened. In all honesty, they return every now and then, but I won’t express them anymore. Is this suicide prevention? Well, I’m still alive, so technically it is. But it is not the compassionate type of suicide prevention I think is most desirable.

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