Podcasts about patient health questionnaire

May is Mental Health Awareness Month!Mental Health Mississippi was developed to make that process easier and to serve as a hub of information for all mental health resources available in our state.Hinds Behavioral Health Services (Region 9)specializes in outpatient community mental health services for adults, children and youth, families, elderly, and those with chemical dependencies and substance use disorders. Our mission is to provide quality, effective mental health services to the citizens of Hinds County.In a mental health crisis you need help fast. Call us and we will come to you. 601-321-2400 24/7Mobile Crisis Response Team 601-955-6381. Mobile Crisis Teams provide guidance and support to adults and children who are experiencing a mental health crisis. The teams work closely with law enforcement to reduce the likelihood that a person experiencing a mental health crisis is unnecessarily placed in a more restrictive environment, like jail, a holding facility, hospital, or inpatient treatment.Region 8 Mental Health Services provides services in five central Mississippi counties, but if you need immediate crisis assistance, contact your Mobile Crisis Response Team.PHQ-9 (Patient Health Questionnaire-9)Psychology Today: Find a Therapist, Psychologist, Counselor. Hosted on Acast. See acast.com/privacy for more information.

Are screens just a habit for young people, or something far more harmful? In this episode, psychologist and researcher Dr. Jean Twenge, author of iGen and Generations, breaks down how screen time — especially social media and gaming — is hijacking teen mental health. From rising rates of depression and anxiety to her powerful “A-N-D” framework (Attachment, Negative experiences, Displacement), Jean explains why so many teens are struggling — and what we can do to help. Hear what the latest research really says, what most headlines miss, and how we can help young people reclaim their wellbeing in a digital world. Featured Expert  Jean Twenge, PhD Books iGen, by Jean Twenge Generations, by Jean Twenge Research References Social Media and Mental Health: A Collaborative Review. An ongoing open-source literature review posted and curated by Jean Twenge, Jonathan Haidt and Zach Rausch. Richardson, L. P., et al. Evaluation of the Patient Health Questionnaire-9 Item for Detecting Major Depression Among Adolescents. PEDIATRICS, 126(6), 1117–1123, 2010. SAMHSA. 2023 NSDUH Annual National Report | CBHSQ Data. 2023. Time Code  00:00 Introduction 01:16 Interview with Jean Twenge: Exploring Generational Differences 02:13 The Impact of Social Media on Teen Mental Health 03:58 Attachment, Negative Experiences, and Displacement: The AND Framework 05:03 Hearing teens' voices  09:02 Broader Implications of Screen Time 17:16 Understanding Depression Statistics and Misleading Headlines 20:48 The Importance of Sleep for Mental Health 24:18 Parental Strategies and Societal Changes 28:19 Conclusion and Resources

Episode 161: Depression FundamentalsFuture doctors Madeline Tena and Jane Park define depression and explain different methods to diagnose it. Non-pharmacologic and pharmacologic treatment is mentioned briefly at the end.  Written by Madeline Tena, MSIII, and Jane Park, MSIII. Western University of Health Sciences, College of Osteopathic Medicine of the Pacific. Editing by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Definition. Per the language of Mental Health, depression can be defined as a mood, a symptom, a syndrome of associated disorders, or a specific mental disorder. As a state of mood, depression is associated with feelings of sadness, despair, emptiness, discouragement, and hopelessness. The sense of having no feelings or appearing tearful can also be a form of depressed mood. A depressed mood also can be a part of a collection of symptoms that explain a syndrome. Depression as a mental disorder can encompass depressive syndromes. Per the American Psychiatric Association DSM-5-TR, depressive disorders commonly include sad, empty, irritable mood, accompanied by changes in one's functional capacity. They can be classified by severity and recurrence, and associated with hypomania, mania, or psychosis. Depressive disorders include major depressive disorder (including major depressive episodes), persistent depressive disorder, premenstrual dysphoric disorder, substance-induced depressive disorder, depressive disorder due to medical condition, other specified depressive disorder, and unspecified depressive disorder.Today, we will cover unipolar depressive disorder, also known as major depressive disorder. MDD.Major depressive disorder is a mood disorder primarily characterized by at least one major depressive episode without manic or hypomanic episodes. Depressive episode is a period of at least 2 weeks of depressed mood or anhedonia in nearly all activities for most of the day nearly every day, with four or more associated symptoms in the same 2 weeks. We will discuss specific symptoms for diagnosis further on. Epidemiology of depression.Nationally or regionally representative surveys in 21 countries estimate that the 12-month prevalence of major depressive disorder across all countries is 5 percent. Furthermore, the prevalence of major depressive disorder plus persistent depressive disorder in developed countries (United States and Europe) is approximately 18 percent. Multiple studies consistently indicate that in the general population of the United States, the average age of onset for unipolar major depression and for persistent depressive disorder (dysthymia) is approximately 30 years old. During 2020, approximately ⅕ US adults have reported receiving a diagnosis by a healthcare provider, with the highest prevalence found among young adults age (18-24 year age… generation Z). Within the US there was considerable geographic variation in the prevalence of depression, with the highest state and county estimates of depression observed along the Appalachian and southern Mississippi Valley regions. Why do we care about depression?Because depression is associated with impaired life quality. It can impair a patient's social, physical, and psychological functioning. Also, depression is associated with mortality. A study done by UPenn Family Practice and Community Medicine in 2005 showed that among older, primary-care patients over a 2-year follow-up interval, depression contributed as much to mortality as did myocardial infarction or diabetes. A prospective study from 2005-2017 that followed 186 patients for up to 38 years further showed that patients with major depressive disorder had 27 times higher incidence rate of suicide than the general population. (1, 2). Also, patients dying by suicide visit primary care physicians more than twice as often as mental health clinicians. It is estimated that 45% of patients who died by suicide saw their primary care physician in the month before their death. Only 20% saw a mental health professional a month before their death. (3)Suicidality in depression.It seems that primary care physicians often do not ask about suicidal symptoms in depressive patients. A 2007 study by Mitchell Feldman at the University of California San Francisco showed that 152 family physicians and internists who participated in a standardized patient with antidepressants, suicide was explored in only 36% of the encounters. (4)Physicians, including primary care physicians, should ask patients with depression about suicidality with questions such as: Do you wish you were dead? In the past few weeks, have you been thinking about killing yourself? Do you have a plan to kill yourself? Have you ever tried to kill yourself? (5) Screening for depression.The USPSTF recommends screening for depression in all adults: 18 years old and over regardless of risk factors. Some factors increase the risk of positive screening, such as temperament (negative affectivity/neuroticism), general medical illness, and family history. First-degree family members of people with MDD have a 2-4 times higher risk of MDD than the general population. Furthermore, social history can increase risk as well: sexual abuse, racism, and other forms of discrimination.It is important to highlight the risk in women because they may also be at risk related to specific reproductive life stages (premenstrual period, postpartum, perimenopause). The USPSTF includes pregnant individuals and patients in the postpartum period to be screened for depression. Screening tools. The US Preventive Services Task Force recommends depression screening for major depressive disorder (MDD) in adolescents aged 12 to 18 years (grade B). Similarly, the Guidelines for Adolescent Depression in Primary Care (GLAD-PC) has also recommended annual screening for depression in children aged 12 and older. (6) Some tools used for screening in this age group are the Patient Health Questionnaire for Adolescents (PHQ-A) and the primary care version of the Beck Depression Inventory (BDI). For the general adult population, it is recommended that all patients not currently receiving treatment for depression be screened using the Patient Health Questionnaire-2 (PHQ-2) (7)PHQ 2 is a survey scored 0-6. The survey asks two questions: Over the last 2 weeks, how often have you been bothered by any of the following problems?Little interest or pleasure in doing things.Feeling down, depressed, or hopeless.Answers should be given in a numerical rating. 0=Not at all; 1=Several days; 2=More than half the days; 3=Nearly every day. A score ≥ 3 is considered positive, and a follow-up full clinical assessment is recommended. The PHQ-2 has a sensitivity of 91% and a specificity of 67% when compared to a semi-structured interview. Keep in mind that the PHQ-2 may be slightly less sensitive to older individuals. Individuals who screen positive with PHQ-2 should have additional screening with the PHQ-9, which is a nine-item, self or clinician-administered, brief questionnaire that is specific to depression. (8) Its content maps directly to the DSM-5 criteria for major depression. (9)The PHQ-9 is a set of 9 questions. The answers are scored similarly to PHQ-2, with a numerical scoring between 0 and 3. (0=Not at all; 1=Several days; 2=More than half the days; 3=Nearly every day). Dr. Arreaza, you will be my patient today, are you ready? It's important that you think about the last 2 weeks.Over the last 2 weeks, how often have you been bothered by any of the following problems?Little interest or pleasure in doing things. [Dr. Arreaza answers, “sometimes”. Jane asks, “is it several days or nearly every day?”. Dr. Arreaza answers, “nearly every day” 3]Feeling down, depressed or hopeless [Dr. Arreaza: every day 3]Trouble falling or staying asleep, or sleeping too much [Dr. Arreaza: not at all 0]Feeling tired or having little energy [Dr. Arreaza: not at all 0]Poor appetite or overeating [Dr. Arreaza: every day 3]Feeling bad about yourself- or that you are a failure or have let yourself or your family down [Dr. Arreaza: several days 1]Trouble concentrating on things, such as reading the newspaper or watching television [Dr. Arreaza: Several days 2]Moving or speaking so slowly that other people could have noticed. Or the opposite, being so fidgety or restless that you have been moving around a lot more than usual. [Dr. Arreaza: Not at all 0]Thoughts that you would be better off dead, or of hurting yourself [Not at all 0]Jane: Your score is 12.Maddy: Regarding severity, a total score of 1-4 suggests minimal depression. 5-9 suggests mild, 10-14 moderate, 15-19 moderately severe, and 20-27 severe depression. PHQ-9 with patients' scores over 10 had a specificity of 88% and sensitivity of 88% for MDD. (10)But if there are at least 4 non-zero items, including question #1 or #2, consider a depressive disorder and add up the scores. If there are at least 5 non-zero items including questions #1 or #2, consider major depressive disorder specifically. The questionnaire is the starting point for a conversation about depression.A couple of things to note: 1. Physicians should make sure to verify patient responses given the questionnaire can be self-administered. Diagnosis also requires impairment in the patient's job, social, or other important areas of functioning. 2. Diagnosis requires a ruling-out of normal bereavement, histories of manic episodes, depressive episodes better explained by schizoaffective disorder, any superimposed schizophrenia, a physical disorder, medication, or other biological cause of depressive symptoms.Once a patient is newly diagnosed and/or started on treatment, a regular interval administration (e.g. 2 weeks or at every appointment) of PHQ-9 is recommended. The PHQ-9 has good reliability, validity, and high adaptability for MDD patients in psychiatric hospitals for screening and evaluation of depression severity. (12) Other than PHQ-9, there is also Geriatric Depression Scale-15 for older patients with mini mental status exam (MMSE) that scored over 10. (13)For postpartum depression, the preferred screening tool is the Edinburgh postnatal depression scale[Click here (stanford.edu)].Non-pharmacologic and pharmacologic treatment.Now that we have diagnosed the patient, we have to start management. Patients can consider non-pharmacologic treatment such as lifestyle modifications. This can include sleep hygiene, reduction in drug use, increased social support, regular aerobic exercise, finding time for relaxation, and improved nutrition. Furthermore, based on severity, patients can start psychotherapy alone or psychotherapy + pharmacotherapy. Admission is required for pts with complex/severe depression or suicidality. There should be an assessment of efficacy at 6 weeks.There is a warning about patients aged 18-24 who are at increased risk of suicide when taking SSRI within the first couple weeks of treatment. Mediations: SSRI, SNRI, tricyclic antidepressants, MAOIs, and Atypical antidepressants: including trazodone, mirtazapine (Remeron), bupropion (Wellbutrin SR). More research is being done on psychedelic drugs such as ketamine and psilocybin as possible treatments. There are therapies such as ECT available too.Potential Harm of Tx: Potential harms of pharmacotherapy: -SNRI:  initial increases in anxiety, insomnia, and restlessness, and possible sexual dysfunction and headaches as well. Compared with the SSRI class, the SNRI class tends to induce more nausea, insomnia, dry mouth, and in rare cases hypertension.-Tricyclic: Cause of numerous side effects, very infrequently prescribed unless the patient is not responding to other forms of treatment. Side effects that are included are: dry mouth. slight blurring of vision, constipation, problems passing urine, drowsiness, dizziness,  weight gain, excessive sweating (especially at night). Avoid TCAs in elderly patients.-MAOIS: MAO-IS can cause side effects too, including dizziness or lightheadedness, dry mouth, nausea, diarrhea or constipation, drowsiness, and insomnia. Furthermore, other less common side effects can include involuntary muscle jerks, hypotension, reduced sexual desire/ ability to orgasm, weight gain, difficulty starting urine flow, muscle cramps, and paresthesia.Remember to screen your patients. In case you establish a diagnosis, discuss treatments, including non-pharmacologic and pharmacologic options. Warn your patients about side effects and the timing to see the benefits of the medication, usually after 6 weeks. __________________Conclusion: Now we conclude episode number 161, “Depression Fundamentals.” Future doctors Park and Tena discussed depression and its risk factors, screening, and treatment. They went through the PHQ2 and PHQ9 as screening tools, as well as commonly used treatments and their side effects, such as SSRIs. Dr. Arreaza also highlighted the importance of asking about suicidality in your depressed patients, there is a lot of room for improvement in that aspect. This week we thank Hector Arreaza, Madeline Tena, and Jane Park. Audio editing by Adrianne Silva.Talk_OutroEven without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Angst F, Stassen HH, Clayton PJ, Angst J. Mortality of patients with mood disorders: follow-up over 34-38 years. J Affect Disord. 2002;68(2-3):167-181. doi:10.1016/s0165-0327(01)00377-9. https://pubmed.ncbi.nlm.nih.gov/12063145/Miron O, Yu KH, Wilf-Miron R, Kohane IS. Suicide Rates Among Adolescents and Young Adults in the United States, 2000-2017. JAMA. 2019;321(23):2362-2364. doi:10.1001/jama.2019.5054. https://pubmed.ncbi.nlm.nih.gov/31211337/ Feldman MD, Franks P, Duberstein PR, Vannoy S, Epstein R, Kravitz RL. Let's not talk about it: suicide inquiry in primary care. Ann Fam Med. 2007;5(5):412-418. doi:10.1370/afm.719. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2000302/.Brief Suicide Safety Assessment,National Institute of Mental Health (NIMH), July 11, 2020. https://www.nimh.nih.gov/sites/default/files/documents/research/research-conducted-at-nimh/asq-toolkit-materials/adult-outpatient/bssa_outpatient_adult_asq_nimh_toolkit.pdfBeck A, LeBlanc JC, Morissette K, et al. Screening for depression in children and adolescents: a protocol for a systematic review update. Syst Rev. 2021;10(1):24. Published 2021 Jan 12. doi:10.1186/s13643-020-01568-3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802305/Williams, John; Nieuwsma, Jason. Screening for depression in adults, UpToDate, updated on November 30, 2023. https://www.uptodate.com/contents/screening-for-depression-in-adults.Instrument: Patient Health Questionnaire-9 (PHQ-9), National Institute on Drug Abuse, https://cde.nida.nih.gov/instrument/f226b1a0-897c-de2a-e040-bb89ad4338b9.Lowe B, et al. Monitoring depression-treatment outcomes with the Patient Health Questionnaire-9 (PHQ-9). Med Care, 42, 1194-1201, 2004.Sun, Y., Fu, Z., Bo, Q. et al.The reliability and validity of PHQ-9 in patients with major depressive disorder in psychiatric hospital. BMC Psychiatry20, 474 (2020). https://doi.org/10.1186/s12888-020-02885-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701937/Conradsson M, Rosendahl E, Littbrand H, Gustafson Y, Olofsson B, Lövheim H. Usefulness of the Geriatric Depression Scale 15-item version among very old people with and without cognitive impairment. Aging Ment Health. 2013;17(5):638-645. doi:10.1080/13607863.2012.758231. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701937/.Royalty-free music used for this episode: Old Mexican Sunset by Videvo, downloaded on Nov 06, 2023 from https://www.videvo.net

Dr. April Dominick // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member April Dominick  continues with part 2 of her series on postpartum depression. In this episode, she discusses how rehab providers can screen for postpartum depression. She also offers tips for communicating with clients who we suspect have postpartum depression with scripted suggestions and responses to support a client in the moment. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION 00:00 - APRIL DOMINICK What's up PT on Ice Daily Show fam? My name is Dr. April Dominick, and today I'll discuss how to screen for postpartum depression and share tips and scripted phrases that you can practice saying to get comfortable supporting someone you suspect has postpartum depression. In the ice pelvic division, updates and course offerings are going to be that we are on the road October 13th and 14th in Milwaukee, Wisconsin. And your next opportunity after that will be with myself and Dr. Christina Previtt. We will be tackling all things pelvic health in the Pacific Northwest in Corvallis, Oregon, and that's gonna be October 21st and 22nd. So head over to PTOnIce.com and grab your seat. Our final courses for the fall are still listed, and you still have a few chances to catch us live. So in episode 1553, that was the last episode I did of this postpartum series, depression series, we talked about prevalence rates, we defined postpartum depression, and we talked about risk factors for postpartum depression. Since then, I ran across another systematic review from 2017 that cited worldwide greater than 10% of pregnant and immediate postpartum women are having depressive episodes, greater than 10%. That number is still astounding to me. While screening for PPD or postpartum depression is one thing, if someone is sharing that they're struggling and you sense they have some signs and symptoms of postpartum depression, we as providers may feel empathy for the person in front of us, but we may be at a loss of words for how to communicate that with another individual. So in the second half of today's episode, I'll go through a few key phrases that you can build off of in response to someone you suspect having postpartum depression, with the ultimate goal, of course, being referring them to the appropriate mental health provider and or medical provider. 00:00 - SCREENING FOR POSTPARTUM DEPRESSION But first, let's chat about how we can screen for postpartum depression. Just a quick definition of postpartum depression, it is going to be someone with moderate to severe depressive symptoms. That can arise around post childbirth whenever that occurs, all the way up to four weeks post childbirth. And then that can also last for up to a year or more postpartum. Postpartum depression, it affects daily functions. So someone has some struggles with chores or daily childcare tasks compared to the baby blues, which is a more mild form of depression. Postpartum depression does require medical intervention as well. So pregnancy and postpartum, as we all know, is a time of psychological vulnerability, especially in those first few weeks when there's so much transition happening after delivery, which is why early identification and screening for treatment is key. So we want to ask the questions, whether that's verbally or in a paper or outcome measure form. So ACOG recommends that patients be screened for postpartum depression at a few certain timeframes. At the first OB visit, at 24 to 28 weeks gestation, and there was a study in 2013 by Wisner et al that suggested for a majority, depression begins prior to delivery. So this is why we have those checkpoints during pregnancy. And then the other times that they suggest that we screen for postpartum depression is at the comprehensive postpartum visit, whether that's at six weeks, four weeks, eight weeks. And then also I loved this at pediatric visits well into the first postpartum year, because pretty much after that six week visit, um, most women are not seen by their OB until the next year for their annual. So those are some timeframes that we as PTs are likely seeing these individuals maybe during pregnancy, postpartum, so we can also help with this screening process. In terms of outcome measures, there are a number of outcome measures out there that are used to screen for postpartum depression. We are going to go over two of the most common evidence-based tools. The first is the Edinburgh Postpartum or Postnatal Depression Scale, and then the Patient Health Questionnaire. They're both two scales that are recommended by ACOG and by the Postpartum Support International Group, which is a really cool resource, and we'll talk about it more in my next episode, but it's going to be a resource available for those in that perinatal mental health space period kind of combines those two things. So the two outcome measures, the Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire, we love them because they are available in many languages and they are quick to administer and they're free. Who doesn't love free stuff? They are validated also for the perinatal population. which I think is something important that while we can give someone a major outcome measure that's for general depression, it's even really more helpful to have someone go through an outcome measure that is specific to the time and space that they're in. And then scoring, the lower the score for both of the outcome measures is going to indicate lower or more mild depressive symptoms. The cutoff value of 11 or higher out of 30 for the Edinburgh scale is going to maximize the combined sensitivity and specificity. 07:21 - THE EDINBURGH POSTNATAL DEPRESSION SCALE (EPDS) Let's go through a couple of differences, though, between what we'll call the EPDS for the Edinburgh Postnatal Depression Scale. So for the EPDS, it's got 10 questions. And not only does it address the depressive symptoms and suicidal thoughts, but it also has an anxiety component of perinatal mood disorders. And that anxiety piece is likely what contributes to it being the most widely used screening tool. The other interesting thing I came across is that the EPDS is actually reliable and a valid measure of mood in the supporting partner, whether it is a male or a female, which I think is great. Example of items from the EPDS. are as follows. The person is going to be answering whether or not they have been so unhappy that they have been crying, the thought of harming myself has occurred to me, or I have felt scared or panicky for no good reason. Moving to the patient health questionnaire, that's going to be nine questions that assess for the depression component. It does include an item about suicidal ideation, but it doesn't have an anxiety component that the EPDS does. Instead, it includes some of the somatic symptoms of major depressive disorders, such as fatigue, sleep disturbance, changes in weight, and these reflect what is also on the DSM categories. Here's an aside for all these outcome measures. So in my research, I ran across a study from 2017 by Ukatu et al, reviewing about 36 articles that used PPD screening tools, and they investigated the outcome measures and their ability to detect maternal depression. So two of the conclusions from this review that looked at a bunch of articles that use PPD were, one, is that they found no recommendation could be made about the most effective tool for detecting PPD, which is, I guess the good side of that is you can use, there are a lot of tools out there and they will likely be capturing the depression component. 10:28 - WHEN IS THE ONSET OF POSTPARTUM DEPRESSION? The other thing that they mentioned was there's no recommended time duration in which to screen patients, again, from all of those reviews that they studied. So one of the reasons they suggest that the timing can be difficult to recommend is that For certain outcome measures that are administered at the two-week mark, the outcome measure may not be able to differentiate symptoms of baby blues, which commonly ends after about two weeks post-birth, versus postpartum depression that can have a much later onset. And that can be anywhere from post-birth up to three to four weeks for onset. So I just thought that was an interesting find from the screening side of things. But the two that we talked about are the EPDS and the patient health questionnaire. So outside of administering those two outcome measures, when it comes to screening, you'll want to also use the power of your ears and your voice to catch anything that may have been missed in those outcome measures. Remember, some people won't necessarily be honest on the outcome measures. They may be less likely to share that they're struggling due to the feelings of shame, abandonment, maybe they have a lot of guilt about not being enough for their baby, or they may not even realize their current emotional state, even when asked right on the outcome measure. So be an active listener. Ask the person How are you doing? But don't stop there. If you get a general response that's like, I'm good or I'm okay, I think you should ask it again. Say, I'm going to ask you again, how are you doing? Then you should also be on the lookout for words or phrases that the person may use in their conversation, like dark, heavy, blue. And then we certainly also want to have screening out postpartum psychosis in the back of our minds. So hearing voices that tell me to drop my baby, if you hear that, that is very serious. It is a medical emergency. This postpartum psychosis is going to affect about one to 3% of moms. So that's how to screen postpartum depression. How do we have the difficult conversation? How do we navigate the intricacies? when we suspect the person in front of us may be suffering from some postpartum depression. A few general tips. You'll want to listen with compassion and empathy, particularly to the non-physical symptoms. As neuroscientist, Dr. Andrew Huberman said, says, use your body to shift the mind. An individual that's not functioning at their usual physical capacity, or is in pain, or I don't know, recovering from a human body coming out of their body, or they're lacking sleep, right? This does not only affect the physical body, but it's also going to affect the brain and the soul. So it is within our scope to chat about this as their mental status is linked to their physical healing and recovery and management of their condition. As a provider, ignoring their mental status is not an option. You'll also want to avoid being dismissive. So someone may have been very vulnerable with you and they shared that, you know, they're just struggling. They're struggling to find the energy. They're struggling to feed themselves. And then you as a provider, like, okay, moving on to range of motion of your leg, like absolutely not. That is not acceptable. So avoid being dismissive, hear them out. Then remind them that addressing their mental health now will be so much more beneficial than months or a year down the line. And then mentioning that you'd like to take an integrative approach and refer them to a medication provider or their OB or a PCP or a psychiatrist, right? We'll talk in the upcoming podcast, but medications like antidepressants are also a good treatment option for them. So what are some specific responses that you can practice or just have in the back of your head when you suspect someone may be experiencing postpartum depression? I don't know about you, but especially in the public health space, I tend to get, you know, we talk about intimate subjects and there are some times that someone will share something with me. And I mean, I am feeling so much for them, but I have a hard time putting into words the quote right thing to say. And I'm not saying that these things, these scripting phrases that I'm going to give you are the right thing, but it's something to go off of if you're just struggling in that way. 16:43 - HIGHLIGHT & CELEBRATE So the first phrase, and I think it's probably one of the most impactful, your feelings are validated. I'm in a group text with a few moms and one of them, they've all been recently pregnant and recently postpartum. Some of them have been going through some tough times when it comes to emotions. And one of them said, my OB put her hand on my arm and told me how brave I am for asking for help and really realizing that I need to be my best self for my family. And she told me I could call her office anytime to talk to her. And that meant so much. So just letting the person in front of you know your feelings are validated. Number two, early identification. So if you've got someone who is pregnant and you suspect that they're going through some tough times from an emotional standpoint, you can say, you don't have to feel this way for the next eight months of your pregnancy. There are resources available. Number three, highlight and celebrate the person's abilities. Say, look at what you're doing. All of this is very impressive given the circumstances and all the stress that you've been under. Bring it back to a potential or current bond with the baby. And you know, if the baby's in the room with you, even better, have a little side conversation before the appointment starts with the baby. When I point to you, look at your mother with loving eyes. I'm just kidding. But definitely show the person or show the mother, look at how you're learning what your baby needs, right? For comfort, for snuggles, for food, for diaper changes. So remind her of the role she's playing. And then number four, remind her your health is a priority just as much as the baby's is. So often, as soon as labor and delivery is over, maybe we have that six week, postpartum visit, the rest of the visits are not for the mother, they're for the child. So just reminding her that her health is definitely linked and just as important to her baby's health. And then number five, say this happens. There's a fine line though between normalizing that this happens a lot, but also it's not so normal that you don't need to address, that we can't have you not address it. So there was a resource that is, was in the deep dive realms of the ACOG website and the title, the title just gives me chills. It says, how do you talk about mental health conditions in a strength-based way? Love that. Here were their suggestions. Say mental health conditions are common. Mental health conditions are like medical conditions or like diabetes. They need to be treated. Medical conditions are, or mental health conditions are treatable. And that reminding the client that the aim is that every woman who is pregnant or postpartum or every person who's pregnant and postpartum is screened for mood disorders. They also recommended that their clinical support office staff needs to be skilled in talking to patients in a strength-based way, as they may be the first to encounter a postpartum person. And I wholeheartedly believe that because the face of the first person you encounter can really and truly change the trajectory of your care. So let's sum things up. If you're a healthcare provider, interacting with someone In the pregnant and postpartum period, you are in a unique position to be screening for postpartum depression. We covered using two outcome measures such as the Edinburgh Postnatal Depression Scale or the Patient Health Questionnaire. If we suspect PPD, we as rehab providers can be confident in having these early conversations early on and during the client's pregnancy and then again in the early postpartum period. Using tips and verbal responses, the scripting phrases that I mentioned, can help support and validate the client's concerns in a strength-based way. Reminding them that their health is equally as important as their baby's. Reminding them of what they've accomplished under these incredible circumstances. And telling them, hey, this condition is treatable, just like we would treat a shoulder injury. This awareness can decrease stigma, it can normalize screening and detection, and encourage women to discuss any mental health concerns with you. Join us next time for specific treatments, resources, and ways to support a person with postpartum depression. Cheers, y'all. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Welcome back to Birth, Baby!In today's episode we will talk about mental health in the perinatal period. We will explore the difference between Baby Blues and PMADs (Perinatal Mood and Anxiety Disorders). We will discuss how to decide if you need to seek support, and how to find that support if you find you need it.Our guest today is Cheryl Reeley. Cheryl is a Licensed Clinical Social Worker and provides people with effective therapy services specializing in perinatal mental health during pregnancy, postpartum, and the transition to parenthood.Cheryl has been licensed since 2011 and was previously employed as a medical social worker in Urbana, Illinois. During her time in the hospital setting, she provided services to the NICU, OB, L&D, Maternal Fetal Medicine, and Pediatrics. In 2013, she and her family moved from central Illinois to Austin and have been enjoying everything Texas has to offer. In 2021, Cheryl opened her private practice, Cheryl Reeley LCSW PLLC, and has enjoyed making connections in the perinatal and birthing communities.Website: www.CherylReeleyLCSW.comEmail: Cheryl@CherylReeleyLCSW.comPhone: 512-641-9528Links:PHQ-9 - AnxietyPHQ-9 (Patient Health Questionnaire-9) - MDCalcEPDS - Depressionhttps://perinatology.com/calculators/Edinburgh%20Depression%20Scale.htmSummaryCheryl Reilly, a licensed clinical social worker specializing in perinatal mental health, joins Sierra and Samantha to discuss perinatal mood and anxiety disorders (PMADs). Cheryl shares her personal journey and how she got into maternal mental health. They discuss the difference between baby blues and PMADs, the various types of PMADs, and the risk factors associated with them. Cheryl emphasizes the importance of reaching out for help and finding a therapist who specializes in perinatal mental health. She also highlights the role of partners in supporting someone experiencing a PMAD.TakeawaysPerinatal mood and anxiety disorders (PMADs) can occur during pregnancy and the first year postpartum and include depression, anxiety, and postpartum psychosis.Baby blues typically start around day three or four postpartum and resolve around day 14, while PMADs often peak around month four.Risk factors for PMADs include trauma history, socio-economic instability, personal or family history of anxiety or depression, and the transition into parenthood.Partners play a crucial role in supporting someone with a PMAD by validating their experiences, listening to their concerns, and helping them seek professional help.It is important to reach out for help and find a therapist who specializes in perinatal mental health, even if you don't have a formal diagnosis.Please feel free to reach out to us with any recommendations for show episode ideas. If you'd like to be a guest, email us with some information about yourself and what type of podcast you'd like to record together. Thank you for all of your support and don't forget to follow and review our podcast, Birth, Baby!Instagram: @‌BirthBabyPodcastEmail: BirthBabyPodcast@gmail.comWebsite: https://birthbabypodcast.transistor.fm/Intro and Outro music by Longing for Orpheus. You can find them on Spotify! (00:00) - Introduction (01:05) - Cheryl's Background and Journey into Maternal Mental Health (06:31) - Understanding Perinatal Mood and Anxiety Disorders (PMADs) (07:00) - Differentiating Baby Blues from PMADs (09:50) - Intensification of Symptoms over Time (12:33) - Types of PMADs and Signs to Look Out For (16:27) - The Importance of Partners in Supporting Someone with a PMAD (32:27) - Final Advice and Conclusion

Hello & welcome the audience to episode 1, season 3 of deep roots with NaijaBabeinTexas. I have a fabulous guest, “Dr. Ijeoma Ajufo,” on the show today; she is a licensed physician specializing in Psychiatry. We will discuss mood disorders, especially depression and bipolar, in our communities. In my experience, Africans, African Americans, Nigerian Americans, etc., don't understand mental health illnesses. We allow the sigma and our religion to impact our ability to ensure our family gets the care they need. People forget that mental illness is as severe as any other health disease, i.e., cancer, diabetes, etc. Our goal is to educate our audience on this topic. Dr. Ajufo and I discuss the causes, risk factors, types, and stigmas of mood disorders. How to recognize the patterns. As well as how to get management and treatment. There are several ways to get care. If you have suicidal thoughts: Please get care immediately by calling 911, going to an Emergency Room, or texting 988 is a Suicide and Crisis Lifeline. For care in Texas: Don't hesitate to contact Dr. Ajufo at her practice. Northridge Behavioral Health Website: northridgebehavioral.com Address: 2829 Babcock Rd, Suite 126 San Antonio, Texas 78229 Tel #: 210-475-3048 Resources: -https://www.who.int/news-room/fact-sheets/detail/depression -https://www.gradschools.com/get-informed/careers/types-of-mental-illnesses PHQ-9 (Patient Health Questionnaire-9) - MDCalc. -https://www.who.int/news-room/fact-sheets/detail/mental-disorders -https://www.mayoclinic.org/diseases-conditions/mood-disorders/symptoms-causes/syc-20365057 --- Send in a voice message: https://podcasters.spotify.com/pod/show/naijababeintexas/message

This episode is brought to you by www.candleconsulting.net  Covering what depression is, criteria for diagnosing, how you get depression, negative effects of depression on relationships, how to support a loved one with depression and protetive factors Patient Health Questionnaire -9 www.therapistaid.com  

Drs Madhukar Trivedi and Lorenzo Norris address the issues of race, equity in care, and the importance of cultural competence when treating patients with major depressive disorder. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/984455). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Depression https://emedicine.medscape.com/article/286759-overview Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) https://www.psychiatry.org/psychiatrists/practice/dsm The Cultural Formulation Interview: Building the Case for Cultural Competence in Clinical Care https://pubmed.ncbi.nlm.nih.gov/36722093/ Shared Decision Making https://www.medscape.org/shareddecisionmaking Promoting Collaborative Psychiatric Care Decision-Making in Community Mental Health Centers: Insights From a Patient-Centered Comparative Effectiveness Trial https://pubmed.ncbi.nlm.nih.gov/33119363/ Structured Clinical Interview for the DSM https://www.appi.org/products/structured-clinical-interview-for-dsm-5-scid-5 Psychometric Properties of Structured Clinical Interview for DSM-5 Disorders-Clinician Version (SCID-5-CV) https://pubmed.ncbi.nlm.nih.gov/33729681/ The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener https://pubmed.ncbi.nlm.nih.gov/14583691/ The PHQ-9: Validity of a Brief Depression Severity Measure https://pubmed.ncbi.nlm.nih.gov/11556941/

Video: No, this intensely aggressive AI isn't fake (details in comment), w Elon Musk. (13:44) PEOPLE FOR PEOPLE RADIO - DR ANA MIHALCEA MD PhD AND GUEST SASHA LATYPOVA 11TH SEPTEMBER 2022  Neil Oliver - '...digital enslavement is coming...'  New Rule: A Unified Theory of Wokeness | Real Time with Bill Maher (HBO)   Omega-3 fatty acid stops known trigger of lupus Michigan State University, September 29, 2022    A team of Michigan State University researchers has found that consuming an omega-3 fatty acid called DHA, or docosahexaenoic acid, can stop a known trigger of lupus and potentially other autoimmune disorders.   "What we discovered was when lupus was triggered by crystalline silica, a toxic mineral also known as quartz that's linked to human autoimmunity, DHA blocked the activation of the disease," said Melissa Bates, one of the study's lead authors in MSU's Department of Food Science and Human Nutrition and the Institute of Integrative Toxicology.   The preclinical study looked at the effect of DHA on lupus lesions in the lungs and kidneys of female mice that were already genetically predisposed to the disease. Their results were overwhelmingly positive.   "Ninety-six percent of the lung lesions were stopped with DHA after being triggered by the silica," said Jack Harkema, another study author and pulmonary pathologist. "I've never seen such a dramatic protective response in the lung before."   Lupus is considered a genetic disease and is triggered not only by inhaling crystalline silica toxicants, but also by other environmental factors such as sun exposure. Quartz is the most common, and most dangerous, form of crystalline silica and is often found in the agriculture, construction and mining industries where workers can breathe in the mineral dust. Lupus is the body's immune system attacking itself and it can damage any part of the body including skin, joints and organs.   Although it's still unknown exactly why DHA is able to prevent the onset of lupus, the researchers said this study provides scientists with a better model for looking at just how much DHA is needed to ward off the environmental trigger of the disease.   According to Harkema, the DHA could be changing the way cells, also known as macrophages, react to the silica in the lungs and somehow alter the immune system's response.   "What we do know is this study is a clear indication that eating DHA can prevent this one type of environmental triggering of lupus," Pestka said. "It can suppress many of the disease's signaling pathways, which current drugs on the market now try to target and treat."     Study offers real-world evidence of vitamin D's protective effects German Cancer Research Center, October 12 2022.  A study reported in the Journal of Internal Medicine provides “real-world” evidence of the benefits of vitamin D supplementation.  “Given the increasing importance of real-world evidence in determining the drug effectiveness outside of the strictly defined and controlled situations of randomized controlled trials, it is of great interest how the efficacy data of vitamin D3 supplementation obtained from well-defined and well-controlled clinical trial populations translate into effectiveness in real-world practice,” the authors remarked. “The primary objective of this study was to investigate whether the intake of vitamin D supplements (in the form of a vitamin D preparation or as part of a multivitamin product) is associated with reduced all-cause and cause-specific mortality including cancer mortality, cardiovascular disease mortality and respiratory disease mortality in the large UK Biobank, a nationwide, population-based cohort from the United Kingdom.” The researchers analyzed information from 445,601 UK Biobank participants. Regular vitamin D supplement use was reported by 4.3% of the participants and multivitamin use was reported by 20.4%.  Vitamin D and multivitamin supplement users had higher median 25-hydroxyvitamin D levels than nonusers. Multivitamin users experienced a 74% reduction in the risk of vitamin D deficiency and users of over-the-counter vitamin D supplements had an 84% lower risk. During the 11.8-year median follow-up, individuals who used multivitamins had a 5% lower risk of mortality and those who used vitamin D had a 10% lower risk compared to nonusers. Regular vitamin D use was associated with 11% lower risk of dying from cancer and a 29% lower risk of mortality from respiratory disease.  “This large study suggests that in the real world, the efficacy of vitamin D supplements in reducing mortality may be at least as good as observed in randomized clinical trials,” the authors concluded.   What you eat could contribute to your menstrual cramps North American Menopause Society, October 12, 2022 Despite the fact that menstrual pain (dysmenorrhea) is the leading cause of school absences for adolescent girls, few girls seek treatment. An analysis of relevant studies suggests that diet may be a key contributor, specifically diets high in meat, oil, sugar, salt, and coffee, which have been shown to cause inflammation. Results will be presented during The North American Menopause Society (NAMS) Annual Meeting in Atlanta. Roughly 90% of adolescent girls experience menstrual pain. Most use over-the-counter medicine to manage the pain but with limited positive results. Evidence has highlighted that diets high in omega-3 fatty acids and low in processed foods, oil, and sugar reduce inflammation, a key contributor to menstrual pain. This analysis was designed to study the effect of diet on menstrual pain and identify which foods contribute to it and which can reduce it. Research was conducted through a literature review that found multiple studies that examined dietary patterns that resulted in menstrual pain. In general terms, these studies found that diets high in omega-6 fatty acids promote inflammation and foods high in omega-3 fatty acids reduce it. The muscles in the uterus contract because of prostaglandins, which are active in inflammatory responses. When measuring the Dietary Inflammatory Index, it was found that those on a vegan diet (that excluded animal fat) had the lowest rates of inflammation. “Researching the effects of diet on menstrual pain started as a search to remedy the pain I personally experienced; I wanted to understand the science behind the association. Learning about different foods that increase and decrease inflammation, which subsequently increase or reduce menstrual pain, revealed that diet is one of the many contributors to health outcomes that is often overlooked. I am hopeful that this research can help those who menstruate reduce the pain they experience and shed light on the importance of holistic treatment options,” says Serah Sannoh, lead author of the poster presentation from Rutgers University. “Since menstrual pain is a leading cause of school absenteeism for adolescent girls, it's important to explore options that can minimize the pain. Something like diet modification could be a relatively simple solution that could provide substantial relief for them,” said Dr. Stephanie Faubion, NAMS medical director.   Free radicals blamed for toxic buildup in Alzheimer's brains Rutgers University, October 10, 2022.  A study reported in Cell Death & Disease revealed a previously unknown mechanism that may contribute to traumatic brain injury and Alzheimer's disease. While a buildup of the protein amyloid-beta has been hypothesized to be the major driver of Alzheimer's disease, the study suggests that another protein, after undergoing oxidation by free radicals, could be a causative factor. "Indeed, scientists have known for a long time that during aging or in neurodegenerative disease cells produce free radicals," explained lead researcher Federico Sesti, who is a professor of neuroscience and cell biology at Rutgers Robert Wood Johnson Medical School. "Free radicals are toxic molecules that can cause a reaction that results in lost electrons in important cellular components, including the channels." Dr Sesti and colleagues determined that oxidation of a potassium channel known as KCNB1 results in a toxic buildup of this protein, leading to increased amyloid-beta production and damage to brain function. "The discovery of KCNB1's oxidation/build-up was found through observation of both mouse and human brains, which is significant as most scientific studies do not usually go beyond observing animals," Dr Sesti reported. "Further, KCBB1 channels may not only contribute to Alzheimer's but also to other conditions of stress as it was found in a recent study that they are formed following brain trauma."     How much radioactivity is in infant formula?  University of Malaya & University of Surrey (UK), October 10, 2022   Based on measurements of radioactivity in samples of infant formula manufactured and sold around the world, researchers estimate that infants 1 year of age or younger who consume these formulas would ingest a significantly higher radioactivity dose than reported levels, but lower than internationally recommended limits. The researchers report the radioactivity levels for each brand of formula in an article published in Environmental Engineering Science, a peer-reviewed journal.   Onoshohwo Bemigho Uwatse and coauthors, University of Malaya (Kuala Lumpur, Malaysia), University of Surrey (U.K.), and King Saud University (Riyadh, Saudi Arabia), determined the levels of radioactive radium, potassium, radium, and thorium in 14 brands of powdered infant milk prepared and sold in various regions around the world. Levels of radioactivity in the formula may vary depending on several factors including radioactivity in the soil, grass, or hay from which the cows were fed, in other raw materials used in processing the formula, or due to processing conditions.   "This paper focuses on a topic that has not drawn significant attention but, nonetheless, has important health implications," says Domenico Grasso, PhD, Editor-in-Chief of Environmental Engineering Science and Provost, University of Delaware.   Using more social media increases depression risk for all personality types, study says University of Arkansas, October 11, 2022 Public policy and education researchers found that higher social media exposure may contribute to depression, regardless of personality traits. In their recent study, high neuroticism was associated with an increased risk of developing depression within six months. On the other hand, low agreeableness was associated with a greater depression risk within that period. The study's authors suggest that interventions should encourage reduced social media use for all personality types, especially high neuroticism, and low agreeableness. Experts have found evidence that suggests that increased social media use (SMU) may increase the risk of developing depression for certain personality characteristics, as the study showed that people low in conscientiousness with high SMU were more likely to perceive social isolation. A new study led by University of Arkansas researchers further explores how personality traits may influence the development of SMU-related depression. The findings appear in the Journal of Affective Disorders Reports.  Merrill and co-authors used data collected over six months by researchers, using a national sample of 978 people aged 18–30.  Merrill explained that her team used the Patient Health Questionnaire to assess depression at baseline and follow-up. The participants in this study reported how much time they spent on 10 leading social media platforms. The researchers assessed personality traits. They examined data for associations between personality characteristics (neuroticism, agreeableness, openness, conscientiousness, and extraversion), social media use, and the development of depression over 6 months. The team found that participants with high agreeableness were 49% less likely to develop depression than those with low agreeableness. However, individuals with high neuroticism were more than twice as likely to develop depression as people with low neuroticism.

Ep33: Nurse Coaches Take Care of Each Other- John Huaylinos, BSN, RN, HN-BC, HWNC-BC Highlights“In today's world it is vital we take care of the person on your left, the person on your right, and the ones that matter the most. When you connect with what matters the most, life is... I've learned life is more rewarding.” ~John HuaylinosAh-Ha'sCOVID has amplified grief and bereavement loss which affects mental wellness on a personal and systemic degreeMental wellness requires advocacy. And includes everything in body, mind and soulEveryone has had scarring to their soul, and when we can recognize this, we can connect at a deeper level to humansNurses can bury themselves in their work, this can lead to suppressing real desires and needs for self-care and self-compassionWhen Nurses explore their desires and need, this leads to self-preservation at a deep levelResources and LinksGAD-7 (General Anxiety Disorder-7) Measures severity of anxiety.PHQ-9 (Patient Health Questionnaire-9) Objectifies degree of depression severity.Integrative Nurse Coach Certificate Program

We have an important episode. We're discussing the association between chronic pain and suicide. The information you'll learn in this episode may help you screen for the risk of suicide more effectively. It may help you effectively treat suicide, and by learning and sharing this information, you may save a life. According to the American Foundation for Suicide Prevention, suicide is the tenth leading cause of death in the United States. In 2019, approximately 48,000 Americans died by suicide. In that same year, there were an estimated 1.4 million suicide attempts. Chronic pain is a risk factor for suicide, and research indicates that chronic pain is present in about 10% of those who die by suicide. It's important as licensed healthcare professionals and loved ones of those who live with chronic pain that we learn how to ask the right questions, assess for risk factors, and intervene to help prevent suicide rates. In a few moments, you'll meet Clinical Psychologist, Dr. Joan Rosenberg, who has conducted research in the field of suicide, as well as treated patients in her clinical practice. Before we begin, I wanted to provide you with some information to effectively ask, assess, and intervene in those you feel may be at risk for suicide, especially those who live with chronic pain. First, I'd like to provide you with a shortlist of factors that may increase the risk of suicidal behavior among people living with chronic pain. If you're a healthcare professional, these might surprise you because we see common risk factors almost every day when we treat people with chronic pain. The first one is insomnia. Insomnia is common among people living with pain and also associated with an increased risk of suicide. The next is an over-reliance on passive coping strategies when you recognize or observe that someone is hoping their pain will go away from these passive coping strategies, increasing their risk of suicide. The next is pain catastrophizing, a topic we've talked about in-depth on this show. All of us are well aware of the catastrophizing pain scale, and there are also other scales and self-report measures that identify catastrophizing. It's very important that we include that in our initial paperwork. The next is prescription pain medication access when other factors are present. We're talking mostly about opioids here. It's not just if someone is taking opioids. There have to be several other factors. The factors that you learned about now present. As we're talking about prescription medication, always be on the lookout for what they call the triple threat, which is opioid, anti-anxiety medication, and alcohol use disorders. Those three together, people oftentimes overdose as well as an increased risk factor for suicidality. There are specific pain diagnoses that have been associated with an increased risk, specifically chronic lower back pain. The diagnosis of psychogenic pain, which is medically unexplained pain or medically explained physical symptoms as well as migraine, those three, chronic lower back pain, psychogenic pain, and migraines. Feelings of helplessness or hopelessness, individuals who will feel that they can do nothing to change or impact their pain and believe that positive outcomes are not possible for them may be at an increased risk for suicide, and then finally isolation or perceived burdensomeness. Oftentimes these go together. If you recognize or identify distressed and interpersonal relationships where someone feels like they are a burden to others or express feelings of not belonging, these are associated with an increased risk of suicide. Suicide can look and sound a lot like depression. It's important that we screen for depression. We all know that depression rates are high in those living with pain. There's a simple way that you can screen for depression in your clinical practice, no matter what type of health professional you are. That's with the PHQ-9, Patient Health Questionnaire-9. It's readily available online if you google Patient Health Questionnaire-9. This is a multipurpose instrument for screening, diagnosing, monitoring, and measuring the severity of depression. It includes nine questions. What's great about this is not only does it screen for depression but question number nine is a single screening question on suicide risk. A patient who answers yes to question nine needs further assessment for suicide risk by an individual who is competent to assess this risk that may or may not be you. Hopefully, by the end of this episode, you will realize that screening for suicide is possible. What I also like about the PHQ-9 is it gives you a couple of different cutoff points for mild, moderate, moderately severe, and severe depression. With those cutoff points, it recommends proposed treatment action for each cutoff point. It's Patient Health Questionnaire-9, super simple, nine questions to screen for depression. Question number nine is specifically for suicide risk. With some of that background information, let's bring in our expert guest, Dr. Joan Rosenberg. Dr. Rosenberg is a cutting-edge psychologist known globally as an innovator in the field of mental health. She is a two-time TEDx speaker and serves as a blogger for Psychology Today and has been a featured expert in multiple documentaries on television and radio. As a licensed psychologist, Dr. Rosenberg speaks on how to build emotional strength and resilience, psychotherapy, and suicide prevention. She's a Professor of Psychology at Pepperdine University in Los Angeles, California, as well as maintains an active clinical practice. This episode aims to create a roadmap or a blueprint for assessing and intervening with suicide. Without further ado, let's begin and learn about this important topic and meet Dr. Joan Rosenberg.   Love the show? Subscribe, rate, review, and share! Here's How » Join the Healing Pain Podcast Community today: integrativepainscienceinstitute.com Healing Pain Podcast Facebook Healing Pain Podcast Twitter Healing Pain Podcast YouTube Healing Pain Podcast LinkedIn Healing Pain Podcast Instagram

Podcast: Understanding Dementia and Delirium   Evaluation and Credit:  https://www.surveymonkey.com/r/MedChat33   Target Audience             This activity is targeted toward primary care and geriatric specialties.   Statement of Need According to WHO, approximately 5-8% of the general population over the age of 60 at a given time will have dementia. The Institute of Aging has projected that those aged 60 and over will increase to 25.6% of Kentucky's population by 2030.  Due to the aging population in Kentucky and the increasing prevalence of dementia it is important for providers to be able to recognize the symptoms of dementia as well as to be able to differentiate clinical characteristics with delirium.   Objectives At the conclusion of this offering, the participant will be able to: Discuss the differences and similarities between dementia and delirium. Identify the symptoms and characteristics of dementia and delirium. Define the different types of dementia. Review the initial treatment options for dementia.   Moderator Carmel Person M.D. Geriatric Medicine Norton Healthcare   Speakers Rachel Hart, D.O.   Geriatric Medicine Specialist Norton Neuroscience Institute   John J. Wernert, M.D., MHA, DLFAPA Executive Medical Director Norton Behavioral Medicine   Moderator and Planner Disclosures  The moderator, speakers and planners for this activity have no relevant relationships to disclose.   Commercial Support  There was no commercial support for this activity.     Physician Credits American Medical Association   Accreditation Norton Healthcare is accredited by the Kentucky Medical Association to provide continuing medical education for physicians.   Designation Norton Healthcare designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.   Resources for Additional Study  Differentiating Between Dementia, Delirium and Depression in Older People https://pubmed.ncbi.nlm.nih.gov/31762251/   Neuropsychological Measures that Predict Progression from Mild Cognitive Impairment to Alzheimer's type dementia in Older Adults: a Systematic Review and Meta-Analysis https://pubmed.ncbi.nlm.nih.gov/29019061/   Patient Health Questionnaire-9 (PHQ-9)   Confusion Assessment Method (CAM)   St. Louis University Mental Status Exam (SLUMs) The Mini-Cog   Norton Healthcare, a not for profit health care system, is a leader in serving adult and pediatric patients throughout Greater Louisville, Southern Indiana, the commonwealth of Kentucky and beyond. Five Louisville hospitals provide inpatient and outpatient general care as well as specialty care including heart, neuroscience, cancer, orthopedic, women's and pediatric services. A strong research program provides access to clinical trials in a multitude of areas. More information about Norton Healthcare is available at NortonHealthcare.com.     Date of Original Release |November 2021 Course Termination Date | November 2023 Contact Information | Center for Continuing Medical, Provider and Nursing Education; (502) 446-5955 or cme@nortonhealthcare.org  

CHRIS NEWBOLD: Hello, Well-being friends. Welcome to the Path to Well-Being in Law podcast, an initiative of the Institute for Well-Being in Law. Obviously, Chris Newbold here, executive vice president of ALPS Malpractice Insurance. We've been very clear on what our hope is for this podcast and that's to introduce you to people doing awesome stuff in the well-being space as we work to build and nurture a national network of well-being advocates intent on creating a culture shift within the profession. I am joined once again by my fantastic co-host, Bree Buchanan. Bree, how are you? BREE BUCHANAN: I'm doing great, Chris. And when you started, just there was a little bit of introduction of yourself, I realized we're well into our 17th or 18th episode of the podcast, which is really exciting. And I just want to let everybody know who we are a little bit again and why we're doing this if people didn't listen to the first episode. And Chris is a great podcast host, he's also an integral part of the Institute for Well-Being in Law, which is who is bringing you this podcast series. He's our vice president of governance and I have the great privilege of being the board president of the Institute. And so just giving you a message from that and the progress that we're doing is it's really exciting to be able to host this podcast, get more involved in communications and spreading the word about the work of the Institute and the well-being movement and getting ready for our annual conference in January of 2022. Lots is happening in regards to the Institute. And so, just a little message for our listeners there. CHRIS: And it's been a wonderful five to seven years since this movement started and there's been one constant in the development of this movement and it's been Bree Buchanan. In terms of being the original co-chair on the national task force on lawyer well-being, Bree has just invested countless hours to give back to the profession through this work and Bree, we're just so fortunate to have you and to continue to have your leadership of this movement. It's important and I just want you to know how much we all appreciate it. BREE: Thank you. I'm glad this is a podcast and not a video because I'm a redhead and I blush easy so I'm flaming red right now. Anyway, to our guest. CHRIS: Let's get to it. Let's get to our guest. Again, we love our guests because our guests are bringing interesting angles and I think it's so important that we think about the collective holistic sense of well-being. And one of the areas that I think really catapulted the movement was the fact that we could actually for the first time, based upon a couple of groundbreaking studies, that we could rely on data to drive the well-being movement. And again, we are an evidence based profession, so the ability for us to really kind of put some numbers behind and some statistics and some scientific nature to the well-being movement, I think it's been really critical in terms of catapulting what we've been working to do to engineer the culture shift. This is again, part two of our, kind of our research focus. We had Larry Krieger on previously and are really excited to introduce you and our listeners today to Matt Thiese. And so Bree, why don't I pass the baton to you to introduce Matt and kick off the podcast? BREE: Sure. Matt, Professor Thiese is really, I think the key position that he holds in the movement right now is to be a lead researcher and looking at what's happening with lawyers today in regards to their well-being and really assisting us getting that data so we know what to do, where to go, what to work on. Matt is an associate professor in the Rocky Mountain Center for Occupational and Environmental Health at the University of Utah. One of 18 centers funded by the Centers of Disease Control and Prevention across the US. He's deputy director for the center, director of the occupational injury prevention program and director of the targeted research training program. Matt has a PhD in occupational epidemiology, a Master's of science in public health and is a prolific writer, having co-authored 99 peer reviewed articles, 46 practice guidelines and 19 book chapters. Whew. Matt, welcome. CHRIS: Busy. Busy guy. MATT THIESE: Thank you very much. Thank you. I'm happy to be here. BREE: Yeah. I warned you a little bit, we have this question, first question we ask all our listeners about what brings you to this work because we found everybody has something that's driving their passion and for you, it's interesting because you're not a lawyer. You come out of the sort of the field of occupational health, which is a new kind of construct for me to think about all of this work that we're doing. Let me ask you the question, what in your life are the drivers behind the passion, your passion for this work? MATT: Sure. I'll start sort of broadly and then get into a little more specifics related to lawyer well-being but just generally occupational health and safety for me is really important. One of my first jobs was working as a mover. I worked as a mover for one day and working there it was during the summer between high school and college. And when you have people in the profession telling you, "Get out, go do something else. This will just tear you apart," it really makes you look and think and say, "Well, you're here, you're 50 years old. You've been doing this for 35 years. Why are you here?" And it's got to be able to be better. There needs to be a way to improve it. That's what got me into occupational health and safety originally and I've just really, really enjoyed it. MATT: We all spend so much time at work, whether we like it or not. And I think any way that you can make that healthier and safer is good for you as an individual but then it's also good for those around you, whether it's your business or your family or both. In terms of law specific, all of my interactions with lawyers have been really positive. And I know a bunch of lawyers. I know a lot of people who went to law school and decided not to actually go practice law and a lot of reasons that they cited were because of the mental challenges, the stress, the depression, that type of stuff. And then I have a neighbor across the street who was really involved and said, "Hey, we would like to be able to have some data to help guide decisions." And I said, "Hey, that's actually something that I know about. What can I do to help?" And that was in 2019 and we've just been off to the races since then. BREE: Wonderful. CHRIS: Again, thank you for your work. We're excited to kind of talk about some of your findings and your first foray into the legal space. Professor Thiese, talk to us about, you're an occupational epidemiologist. That's something that I certainly don't have on my resume. What sorts of things do you study? What's the goal of your work? MATT: Sure. And please call me Matt, unless I'm in trouble, then call me Matthew. And so as an occupational epidemiologist, before the pandemic, epidemiology, I'd say I'm an epidemiologist to people and they say, "Oh, so you study skin diseases? Or what exactly do you do?" The pandemic has been good in that sense, if there's any type of the silver lining, it has really helped highlight the importance of individual health and having data to make these types of decisions. I've done all sorts of different things. Another area of interest for me is transportation health and safety. Truck drivers have all sorts of different challenges. Some of them are oddly somewhat parallel to law professionals but there's all sorts of other things going on with them too. I do all sorts of stuff. Really anywhere your job overlaps with your health, whether that's physical, mental, looking at different types of exposures, chemical hazards, electrocution, slips, trips and falls, automobile crashes, interactions with clients and violence, all of that type of stuff. BREE: Yeah. Matt, you started to intersect with the legal community. I think it came about with the Utah Supreme Court's lawyer well-being task force and made a recommendation that there needed to be a study of their lawyers in their state to see what is sort of the condition of their well-being. And so how did you come to become a part of that? And what happened with that process? MATT: Sure. I don't think actually I am the person who came up with a recommendation. I think that really was the committee had the foresight to say, "Look, we don't even know where our attorneys are on the spectrum. How are we doing? Are there pockets of attorneys that are doing better or worse than others? Are there other individual factors, personal factors? Where do we stand? Basically, let's get a metric at the beginning and then can use that data to make informed decisions." And then I knew some lawyers who were on the committee and they came to me and said, "Hey, can you just come talk with us about this?" And I said, "Absolutely that's right up my alley." We started having a discussion about doing a baseline assessment piece of all lawyers, which then expanded to lawyers and law students and other law professionals like paralegals and legal secretaries to get a baseline. MATT: And then the plan was to do a subsequent followup or a series of follow-ups with those same individuals. In epidemiology terms, that's called a prospective cohort study. You're getting a group of people and then following them through time, that's better than just taking a snapshot at time at different time points of just a random representative sample. It's better to have the individual people. That was the plan. That was 2019. And then the pandemic hit and everything sort of went sideways in terms of being able to contact people in research and everyone's mental health. And now that we're sort of coming back out of that, we're planning on doing our first followup of the same group and then we're actually probably going to end up using that as our new sort of baseline data element, just because so many things have changed due to the pandemic. BREE: Yeah. And just to follow up, so it was the Utah state bar that actually commissioned for you to do the research, is that right? MATT: Correct. Correct. BREE: Okay, great. CHRIS: Matt, what was the lawyer study? Explain for our listeners, what was the objective? MATT: Sure. The objective was to identify, there were a couple. The first was to try and get as representative an assessment as we can of lawyers in Utah, practicing lawyers and in a whole range of areas. We have in our, and it was just a one time survey. It was done online at baseline. We asked about the big ones. Obviously depression, anxiety, burnout, alcohol use, other substance use and abuse. But then we also wanted to ask questions about other aspects of an individual's well-being. We asked about engagement, satisfaction with life, physical activity levels, chronic pain and chronic medical conditions, family life. And we wanted our goal was to keep it short so that we can get a lot of participants. And then also really once we have that baseline, look both within the lawyer population to see if we can identify pockets of individuals, whether that's the type of law they practice or their practice setting. One of the big questions that we had was is there a difference between urban and rural lawyers? That was one. MATT: And then we also used a lot of nationally validated questions and questions that are used nationally so that we could also compare Utah lawyers to general working populations or other large groups. It wasn't just sort of an echo chamber of saying, "Oh well, within Utah lawyers, this is what we see." But really be able to say, "Okay, Utah lawyers compared with general working population other lawyers in other states, what are the differences or what are similarities?" And then ideally, and we've been able to do this highlight sort of some of the challenges statistically to say, "Okay, this random chance? Or is this actually something that in epidemiology is statistically significant and that is beyond what we would expect just by random chance?" CHRIS: And what were your response rates just in terms of again, the scientific validity is always important in your field. I'm just kind of curious on what level of engagement you had from Utah legal professionals. MATT: Absolutely. I'm going to answer that in that sort of a three stage approach. Our first way of recruiting participants was to do a stratified random sample. We got the entire list of active bar members and randomly selected 200 who are rural and 200 who were urban. Send them email invitations asking them to participate. Our participation rate from just those email invitations was surprisingly high. Traditionally, if you were doing this type of a thing, you could get it participation rates in 20 or 30% would be great. We were upwards of 68% from all of those participants. We got a lot of participants that way. We also went to bar conventions and just set up a booth. I have a team of research assistants who were armed with iPads and during breaks or before meetings started and stuff, we just asked if people would be willing to participate, if they have not participated already. It took about our survey was only about five or six minutes long. We had a fair amount of people participating that way. MATT: And then our third route was actually having entire law firms come to us and say, "We would like to know where our firm stands. And not only that, we would like to know where everyone in our firm stands, not just our attorneys." We have 13 different firms of all varying sizes, who we invited to participate. And participation rate for that, depending on the firm was between, I think our lowest was 83% and our highest was 97 and change. Great participation rate. Being a scientist I said, "Okay, is there meaningful differences between these three groups?" Is there in an epidemiological term, is there a self selection bias? Are the people who were at the conferences more likely to participate? Or the people who were in the firms more likely to participate and vice versa? Looking at it, all three groups were statistically equal on almost every metric that I assessed. Not just not statistically different but statistically equal, so interchangeable from a statistical sense. I was nicely relieved and confident that this actually is a pretty good representation of what we have going on here in Utah. CHRIS: You can see you get commissioned, you want to be able to survey the Utah lawyer community. You want to figure out why this is happening and how they can best address the issue. You get great response rates. What did you find from the study? MATT: We're still analyzing stuff. Like any good researcher you want to, one, answering one question begets gets three more. But we're looking at several different things right now. One was looking at comparisons between amounts of depression and among Utah lawyers at compared with the general working population in the United States. We're comparing with individuals who are at least employed three-quarter time in the United States, compared with our attorneys and found that our attorneys are not doing very well. We're calculating odds ratios. An odds ratio of two, for example, means that you're twice as likely to have whatever outcome if you're part of that group. For us looking at depression, the diagnosis and I'm getting a little bit into the weeds here so I apologize, but likely having a diagnosis of a major depressive disorder, our attorneys in Utah were five and a quarter times more likely to have that level of depression as compared with the general working population. BREE: Wow, that's really significant. Just to underscore that, over five times the rate of depression of the general working population, is that right? MATT: Yeah, as compared to the general working population. And that was even after controlling for different, we call them confounders. Other factors that may play a role in that. Age differences or gender differences, other chronic medical conditions, that type of stuff. BREE: Yeah. Did you dig into gender differences? Is that something you are able to talk about at this point, a difference in depressive issues between men and women? MATT: Sure. Yeah, absolutely. In our data, lawyers were about, they were more likely. In general, our lawyers were more likely to be depressed. However, women were more likely to be depressed than men, which also parallels what you see in the general working population or in any other subsets of population. And I'm actually trying to find the exact number because being a scientist, I like to give you that full number. But it was meaningful. We also had our older attorneys were less likely to be depressed compared with the older general working population, which actually is also something that you would expect. It's called the healthy worker effect. And so people who are depressed tend to go try and figure out and solve their depression. Try and get into a better situation. Because everyone's spends so much of their time working, that's one of the common things is people choose a different profession or a different subset of their profession. That healthy worker effect also suggested that what we have here probably actually is a really solid data sample from which to draw some conclusions. CHRIS: Go ahead, Bree. BREE: Well, I know that this has been written up, there was an article in the Utah Bar Journal and then there was another peer reviewed article that I had read. And how has this been received? Do you have a sense that the bar people are surprised at the rate of sort of distress among their members? MATT: I'm going to say yes and no. I think that directionally, there was not a lot of surprise. Looking at ABA report and other research that's out there, it's yes, there is increased rates of depression, anxiety, suicide, alcohol abuse. Those are really the big ones. And I think generally everyone on the committee, in the Utah bar and probably most practicing attorneys say, "Yeah, that's totally believable." I think the part that really was most moving was the magnitude of that relationship. More than five times more likely to be diagnosed with a major depressive disorder but then it gets even worse when you look at the severe group. Our metric that we use is one that's commonly used, it's called the Patient Health Questionnaire 9, it's a nine question battery. It's been well validated to be related to more than 90% accurate for diagnosis of depression and major depressive disorder. The severe people are those who are contemplating suicide or have had suicidal attempts that they're at the far end of the spectrum. Our Utah attorneys were more than 18 times more likely to be in that category as compared to the general working population. BREE: Wow. MATT: Those magnitudes of numbers, when you think about, okay, relationship between things like smoking and lung cancer, you're about two and a half times more likely to get lung cancer if you smoke. We're talking 18 times more likely to be severely depressed if you're a Utah practicing attorney as compared to the general working population. BREE: Wow. CHRIS: Matt, on the front end, did either you or the task force go in with any kind of hypothesis to begin with? Or was this more designed as a kind of compare and contrast national data with state based data? MATT: Yeah, so I definitely did have some hypotheses going into it. One thing that was really great about this relationship with the state bar and the well-being committee was, they said, "This is your domain. These are things that we're curious about but you come up with your hypotheses, you develop the questionnaire." It was completely under my purview, which I think also helped with the recruitment aspect in that it was a recruiting effort done by me through the University of Utah. We used our institutional review board. Everything is strictly confidential, even going through, even with the firms, none of the firms received any individualized data or any potentially identifiable data. The bar does not get any of that. There's some benefits to that but in terms of actual hypotheses, yes. MATT: I mentioned that there potential relationship between the urban and the rural to see if there's differences in well-being there. Looking at different types of practice, whether criminal litigator or transactional law, so on and so forth, as well as looking at the size of the firm. Whether people are solo practitioners or part of a larger firm and trying to actually take all of that into account at once. If someone is a sole practitioner in criminal law in a rural setting, is that sort of just an additive effect in terms of challenges there? Or is it compounded? Or is it sort of somewhat mitigated? Being able to gather enough data to be able to identify some of those relationships was where we were going from the onset. MATT: And then also in my previous work in terms of other working populations and their mental well-being, I knew that things like physical activity, social support, both in the workplace as well as outside of the workplace can have a very positive aspect on both prevention, as well as treatment of mental challenges, mental health challenges. Those are some of the hypotheses that I had created going into this and was able to then tailor the questionnaire to address all of those, both like I said, internal comparisons, as well as comparing with other external groups like general working population. BREE: One of the things, Matt, that we are trying to do with the podcast is to sort of spread the word about strategies, ideas, policies, et cetera, that other state well-being taskforces can pick up and run with. And so a question, just how replicable is this process? You are doing this with Utah lawyers but say there is a task force in Colorado or another state that wanted to do this. Could they pick this up and deploy the same sort of survey for their bar members? MATT: Absolutely. I think not only the same survey, similar methods but then I've also, I've had some conversations with other states and other states have different challenges too. Being able to modify this and ask some other scientifically valid questions to address some of their sort of conceptual questions or anecdotal information that they may have. But it can easily be rolled out and it's something that I think is actually a lot of fun to do. BREE: Good. CHRIS: It feels like there'd be some benefit of actually having again, some standardization across the states that allow us to kind of compare states, yet providing them the ability to be able to narrowly tailor some questions that are specific to our state. Like for instance, I live in Montana, the plight of the solo rural practitioner is something that maybe kind of critically important to look at it relative to a state like Delaware where all the lawyers are kind of more concentrated. But yet it certainly feels like there'd be some benefit there. MATT: Yep. Absolutely. I wouldn't go as far necessarily as benchmarking. But I think that being able to have similarities as well as differences pointed out to say, and one thing, another thing that I've found in doing this research is that a lot of attention is paid to the negative side of things. Depression and anxiety, what are the big risk factors there? But there's the other side of the coin about, okay, who's being really successful? What are the people who are mentally healthy? What do they have in common? And then how can we help to reinforce that? And then, so being able to look within sort of some of those subsets too, can help provide more information. But I absolutely agree, having some similarities across different states would be able to sort of say, it answers that question, how systemic is this? Is this something that's more isolated to our bar? Or is this something that's more of a systemic question across the entire United States? And then how those may have different potential solutions, both on the positive and the negative side of the fence. CHRIS: Yeah. I think this is a good time for a quick break here from one of our sponsors. I would like to kind of come back, I think maybe after the break and maybe talk about whether all the data is grim. And whether there were some nuggets that you picked out of the Utah study. And then talking a little bit more about just kind of barriers to thriving in work in law firm environments and other legal environments. Let's take a quick break and we'll be back. Speaker 4: Meet VERA, your firm's virtual ethics risk assessment guide. Developed by ALPS, VERA's purpose is to help you uncover risk management blind spots from client intake, to calendaring, to cybersecurity and more. Speaker 5: I require only your honest input to my short series of questions. I will offer you a summary of recommendations to provide course corrections if needed and to keep your firm on the right path. Speaker 4: Generous and discreet, VERA is a free and anonymous risk management guide from ALPS to help firms like yours be their best. Visit VERA at alpsinsurance.com/vera. BREE: Welcome back, everybody. And we are here today with Professor Matt Thiese and talking about his study of the Utah bar population and also the potential of replicating that around the country. One of the things I saw, Matt, in the write up of your research that you got some information of barriers that were identified by your survey participants to thriving in their work. And I think that's really instructive for the rest of us. Could you talk a little bit about that? MATT: Sure, absolutely. In the survey we asked both, what are some things that help you thrive and enable you to be able to thrive in your work? As well as your barriers. And there were some consistent answers across all the different domains, regardless of age, gender, type of law practice, practice setting in terms of small firm, large firm, rural, urban. Challenges were actions of other attorneys at their firm or frustrations with opposing counsel. Those were two different obviously responses but talking about individual, other attorneys that they work with. Whether in an adversarial role or in a complimentary role. Others were billable hour requirements, client stress and or pressure. Just external pressure from clients and then inflexible court deadlines. Those were the big five sort of umbrella categories that prevented them from doing well or thriving in their job. CHRIS: And Matt, I think the other thing that I think is interesting about kind of going about a data driven approach, I think sometimes the fear is we get the data and then the data sits on the shelf. One of the things I love about what's happening in Utah is, the Utah state bar's well-being committee is now looking at really kind of more actionable plans to be able to kind of advance the well-being dialogue. And I know one of the things that they have you doing at this point is assessments for legal employers. Can you tell us a little bit more about that? MATT: Sure. That was sort of an organic thing that happened, that came about from this project with the state bar. The bar said, "Let's just get a sample of practicing attorneys in Utah and then go from there." Throughout that process though, we had several managing partners who came and said, "I would love my entire firm to take this and be a part of this." I was able to expand this to use firms, we have like I said, 13 different firms right now who are participating and we invited everyone in their firm to participate. Again, it went through the university so the firm doesn't get any individual information but we are providing information back in a aggregate form to be able to say, "This is where your firm stands and this is how your firm compares with other firms." And these other firms are de-identified. Your firm versus firm A, B, C and D who are comparative in size or that type of stuff, as well as the larger general population that we have participating. MATT: It's been really great. It's been well received. I think firms who are participating are sort of those firms that really want to do something better. They either have something in place and they want to assess how is this making a difference? Or they're thinking of getting something in place, and saying, "Where can we get the largest bang for our buck really?" And they're concerned about making sure that their lawyers are happier and healthier and therefore more productive, more likely to stay with the firm. And really it's a winning situation if you can identify those aspects where people in your firm need more help and then go to the evidence for what's out there to actually provide that. Does that make sense? BREE: Yeah. Yeah. Matt, you've got this background just sort of general long, wide view around occupational health. And so here you come to the specific part of the working population. You've got a little bit of data around lawyers. You're starting to hear some feedback around what's happening with legal employers. Just imagine we've got in your audience, some law firm managers, human resources staff for law firms, based on what you've learned so far do you have any advice to give them, to help them have thriving, successful lawyers? And as a result of that, a more profitable and successful firm? MATT: Right. Yes, in terms of based on what we've seen so far, there's definitely some things that can be done to improve. Taking a step back and saying, all right, I'm going to take an even bigger step back. We're generally have been focusing here on this discussion on depression, but there's a lot of other issues, burnout, anxiety. Looking at the evidence though, for those for prevention and treatment for those, there's some big things like individual therapy, medication, but there are challenges with those as well. There's cost barriers, the time for those both in terms of needed, if you're going to a therapist but then also medication takes, SSRIs, anti-anxiety and anti-depression medication takes three weeks to kick in. If you have someone who's depressed, three weeks can be an awfully long time. MATT: But some of the other treatments out there are actually really easy to implement and there's very little side effects. Two that I would highlight would be physical activity and we have data that's not published yet but found that if you're physically active meeting the standard of most days a week for at least 20 minutes of moderate to vigorous physical activity, so getting your heart rate up enough that you can't carry on a solid conversation, you have to sort of catch your breath, lawyers who were that level of physical activity, so four or five days a week, we're about a third, three times less likely we'll say it that way, three times less likely to have depression or anxiety. If they worked out six days or seven days, they were about between five times and seven times less likely to have depression and anxiety. MATT: Implementing some, and then there's all of the other benefits. Implementing some type of workout, moderate or vigorous workout activity is something that has demonstrated efficacy in other domains. And these preliminary data look like they would help. And then there's the cardiovascular benefits and all those that go along with it, as well as increased productivity after the physical activity, that's a whole other domain that we could talk about maybe at a different podcast. And then another thing is cognitive behavioral therapy and that's a treatment that sounds large and onerous but it's really just being able to approach problems differently and being able to think about things and it can be self directed or you can work with a therapist on it but it's pretty immediate in terms of results like physical activity but it's easy to do and it can help people, whether you're severely depressed, actually, if you're severely depressed, you should probably be seeking additional help beyond just cognitive behavioral therapy and physical activity but all the way to minimal or no depression. People are reporting better engagement, better focus after both physical activity and cognitive behavioral therapy. MATT: Those are two very specific. Maybe they're a little too specific for what you were going for. Other evidence out there in terms of mindfulness and meditation is somewhat mixed. Mindfulness, meditation, psychological capital, those all in general populations have been mixed efficacy but in attorneys, they may be more efficacious. CHRIS: And I'd love to kind of spend the final few minutes talking just a little bit about the replicability of what you've done in Utah in other, not just states, but either state bars, local bars, county bars, specialty bars. There are so many opportunities for us to continue to utilize survey techniques as a way to not just to engage and learn more about the constituencies that we serve. But as you know, surveys can also be great educational tools at the same time. And I just would love your perspective. If again, a lot of our listeners are members of task forces, they're advocates for well-being in their local communities, just how easy is it to kind of execute on a survey tool? Can anybody do it? Just your recommendations for the time, the cost, the structure, obviously when individuals like you have done it before, others have kind of learned on your dime, so to speak. And so I'd just love your perspective about the replicability of utilizing survey tools as part of our well-being strategy map. MATT: Absolutely. Ours was done almost exclusively online, so it's super easy to do. You can implement it. You can have actionable data in a matter of weeks. Ours was all done online and with a few exceptions, we had a couple of opportunities where individuals wanted to talk on the phone or do a paper copy. Email invitations, online data collection aspects in terms of even returning results, a lot of that has also been done online through video conferences and that type of stuff. The whole thing from soup to nuts I think is relatively easy to actually implement. MATT: One of the cautions that I do have though is making sure that it's scientific. Anyone can come up and create a questionnaire but to actually come up with a scientific question, a scientific survey that's using questions that have some validity and comparability is important. And then also your sampling technique. That's always a challenge in that when you're enrolling people, are there biases? Is there a selection bias like I mentioned earlier, where only people who are healthy enough to be participating, mentally healthy enough to be participating are participating? You therefore have a biased sample and any results from that would be either deeply discounted or practically useless. CHRIS: And are you interested in continuing to aid either institutions, entities, taskforces? I know that you've had limited work in the legal space but it sounds like you've enjoyed what you've done thus far. MATT: Yes. Short answer is absolutely yes. Can I give my email address and say reach out? CHRIS: Sure you can. MATT: Please, I would love to participate and help in any way I can, whether that's running the entire thing or anything sort of that. My email address is matt.thiese M-A-T-T dot T-H-I-E-S-E@hsc, for Health Sciences Center, .utah.edu. And I would love to help in any way that I can. Like I said, this is a career focus for me. I've done a lot of work in terms of mental well-being and psychosocial health in other domains. But I really, really enjoyed working with attorneys. I think that it's very, very important. And I think that there's a lot of opportunity here to actually do good. MATT: One of the things that you asked me before was how I fell into this. I was actually planning on going to medical school, was accepted in medical school and in talking with some of my mentors, they said, "You're great at science, you're great at epidemiology and you can actually do more good doing scientific research in epidemiology than seeing patients on a one on one basis and trying to get them to change their behavior." This is absolutely something that is my career focus and I want to help. Can I be more emphatic about it than that? CHRIS: This guy wants work. This guy wants work. MATT: No, and that's the thing, it's not necessarily work. I have a bunch of other stuff going on but in academia I have some of the ability because I'm not out, this is not a business, a profit making business for me. I obviously need to cover my time but I want to be able to help out. And so whatever. CHRIS: Well, I think it's interesting, Matt, and again, I think we should always try to end these on a high note that you've also tried to look at it in your Utah findings, what aspects of their job help them do well or improve their well-being. And I think it was, and I think these are tips for really any work environment, which is if you work in an environment in which you enjoy working with others, in which you're intellectually challenged, in which you have flexibility in your work schedule to some degree and that you know that your contributions are both recognized and valued, that that's a recipe to drive well-being higher. MATT: Absolutely. CHRIS: And those are things that anybody who sets the tone for a culture, anybody who's in HR, anybody who's in management, those are tips that go across industry. They're not unique to the legal environment but it is important in terms of just the notion of how we treat people ultimately drives whether they find their contributions and their commitment worthwhile and whether they will actually want to stay there or not. And those who don't generally then go down one path and those who do you generally have higher productivity, better results. All the reasons why corporate America has kind of I think generally leaned in on well-being as a creative to the bottom line. There's an economic element to it but also frankly, the right thing to do. MATT: Absolutely correct. All of those things that you listed really speak to engagement. And even in the data that we're seeing, you said, it generally leads to better productivity or generally leads to less turnover. I would say most of the data that's out there says it does. There's very few exceptions to that and it's just a matter of the magnitude of that relationship. Having people stay engaged and really that creativity, intellectual challenge, I think is one of the things that came up often helped and reduces, it sort of tempers the negative aspects of things and makes people more resilient and able to handle, less likely to burn out, less likely to be depressed, more likely to be productive. All of that great stuff. CHRIS: Matt, one final question, on the Utah study you've cited a couple times preliminary data. Is there a point in time in which preliminary goes to final data and something is released? MATT: Yes. The depression versus the general working population that we've talked about, those are final. We've looked at those, we're confident in those. In terms of preliminary data, we're looking at burnout and engagement. We're looking at substance abuse, alcohol abuse issues. We're looking at physical activity and then we're also doing similar things with students. The challenges with those are just being able to make sure that we're dotting all of our I's and crossing all of our T's from a scientific standpoint and making sure that we're taking everything into consideration there. And then it goes through a peer review process. We have three separate papers right now that are undergoing the peer review process and then several others that are nearly ready for that. And then dissemination, I would love to help have you guys help disseminate some of these findings and be able to continue to have a positive impact on attorney well-being. BREE: Absolutely. Matt, I'm so glad that you are on our team. Really important piece of this. Well, a wonderful 45 minutes or so with you, Matt. Thank you for spending your time today and dedicating so much of your energy and your expertise to helping us lawyers have to be more likely to thrive in our profession. And for our listeners, please join us again in the next couple of weeks, we'll be continuing our miniseries on those who are doing research and scholarship in the area of lawyer well-being. Thank you, everybody. Stay safe, be well. CHRIS: Thanks for joining us, Matt. MATT: Thank you. My pleasure.  

Episode 28C-PTSD and Recovering from COVIDYou seriously do not want to get this virus.June 2, 2021Well, it now appears I am not just under the influence of COVID-19. I am clinically depressed. Isn't that just peachy? So, I thought it would be helpful to add some information about depression just in case the pandemic has also given you the blues.  You may want to go back and listen to Episode 15: C-PTSD and Depression. There is some good stuff about depression in that podcast.Gary Gilmour wrote a nice piece for Psychology Today. He is Vice-President of Preclinical Research at COMPASS Pathways. Check it out.What Goes On in the Brain of a Person with Depression | Psychology TodayThe Psychiatrist-In-Chief in the Department of Psychiatry of Massachusetts General Research Institute, Maurizio Fava, MD has written on the rise of depression during the COVID-19 pandemic.Depression on the Rise During COVID-19 (massgeneral.org)The Mayo Clinic has posted an article on COVID – 19 and Your Mental Health. This is an article you may want to take seriously.COVID-19 and your mental health - Mayo ClinicArash Emamzadeh, administered the UCLA Loneliness Scale-3, a measure of loneliness, and the Patient Health Questionnaire-9 (PHQ-9), a screening tool for depression, to 1,013 people from 50 U.S. states.  Here's what he learned. COVID-19 Pandemic: Loneliness, Depression, and Suicide | Psychology Today

During this episode, Dr. Janet Patterson, Chief of the Audiology & Speech-Language Pathology Service at the VA Northern California Health Care System talks with Dr. Rebecca Hunting Pompon, assistant professor in the Department of Communication Sciences and Disorders at the University of Delaware in Newark, Delaware, about depression, the effect it can have on people with aphasia and their care partners, and how speech-language pathologists can recognize and address depression during aphasia rehabilitation.   Guest Bio Rebecca Hunting Pompon, Ph.D., is an Assistant Professor in Communication Sciences and Disorders at the University of Delaware, and director of the UD Aphasia & Rehabilitation Outcomes Lab. Prior to completing a Ph.D. in Speech and Hearing Sciences at the University of Washington, she earned an M.A. in Counseling at Seattle University and worked clinically in adult mental health. Dr. Hunting Pompon’s research focuses on examining psychological and cognitive factors in people with aphasia, and how these and other factors may impact aphasia treatment response. She also trains and advises clinicians on interpersonal communication and counseling skills adaptable for a variety of clinical contexts.    In today’s episode you will learn: about the similarities and differences among sadness, grief, and depression, and sobering statistics of their prevalence in persons with aphasia and their care partners, how the behavioral activation model can assist clinicians during planning an aphasia rehabilitation program for an individual with aphasia and his or her care partners, 5 tips to use in starting conversations about depression with persons with aphasia and their care partners, and fostering their engagement in the therapeutic enterprise,  the value of community support groups for persons with aphasia.   Janet: Rebecca, I would like to focus our conversation today on your work investigating depression, and other psychosocial factors that patients with aphasia and their care partners may experience. Let me begin our conversation by asking how we define and think about depression, because I think everyone has an idea about what depression is, and how it may manifest itself in an individual’s interaction with family and friends, and certainly in the past year, as we've moved through this worldwide pandemic, focus on depression has increased. You have studied depression in persons with aphasia, and how depression affects their care, so first, let me ask, how do you define depression? And then how often does it appear in persons with aphasia?    Rebecca: Depression is a concept that so many of us are familiar with. In one way or another, so many people have experienced depression themselves, or alongside a family member, so I think it's such a common concept. Likewise, many people know that the definition of depression that we use most often is about a mood disorder. Usually, the two fundamental ways we think about depression, clinically, is that it is either low mood, or it can be a loss of interest, or pleasure. So of course, we all experience this from time to time, but depression is really a much more marked, persistent low mood or loss of pleasure, or interest, and it can span across days and daily life and make a tremendous impact. Those two features go with some other features like a change in appetite, fatigue and energy loss. Some people experience a slowing of thought or slowing of physical movement, or experience trouble with concentrating, or trouble with focus. It also could include feeling worthless or excessive amounts of guilt, and it also can be accompanied by recurring thoughts of death, which can be with a plan or more abstractly without a specific plan. Those are the constellation of symptoms that can go with that formal depression diagnosis.   Of course, aphasia, as we all know, comes with some significant changes in functioning after stroke or other types of brain injury. Loss and grief are commonly experienced by many people with aphasia and their families as well. Unfortunately, those losses that are experienced with aphasia can lead to depression in a significant number of people. Let me give you a little bit of context on that. In the general adult population, maybe like 9% of the population or so may experience a mild to major depressive disorder at some point; the number goes up for people that have experienced stroke to about 30% or so. In studies of stroke survivors with aphasia, the number is significantly higher. We recently completed a study with about 120 people with aphasia, and about half of them reported symptoms that were associated with a depressive disorder, mild to major. And I think it's really important to note that this is based on 120 people that were motivated to participate, to volunteer for research. We really believe that actually, depression may be experienced by a quite a greater number of people with aphasia, because we're not capturing those people that are at home, they're not engaged in speech therapy, and we really wonder if rates of depression in aphasia might be quite a bit higher.    Janet: That is a stunning set of statistics when you think about all the people who don't report, can't report, or don't come into the clinic, and their feelings; their ideas are pretty much lost in the world. I appreciate the comment that the people participating in your study are motivated, and they experienced depression. It's out there, and we need to pay attention to it. As a clinician, how might one recognize the presence of depression in a client?   Rebecca: Depression can be really hard to observe at times. A lot of people with depression can mask their depression and seem to be doing fine. I've had this experience working with a number of people who seem to be really thriving after their stroke, but then getting into the details and discussing their life and their reactions, we come to find that they're struggling far more than we perceive that they are. Other times we may get some sense of an experience of depression, maybe we observe a lack of initiative or motivation during treatment or get some sense that our client is just not enjoying his or her activities the way that they used to, or the way that we hear from their loved ones, how they used to participate in their life. What do we do if we're wondering, “Hmm, depression? Is this a factor for this particular person?” It can be helpful to ask about the specific symptoms of depression, sometimes more than asking, “Are you depressed?” I that's true for a couple of reasons. First, some of our clients may associate the label of depression as having a lot of stigma. Stigma around mental health has been with us for a very long time, unfortunately, and it's really a barrier to making sure that we can provide care and address issues like depression in many people, not just people with aphasia.  Of course, the other thing about the label of depression is that some people just feel very disconnected from that label. They might hear depression and say, “Well, that's not me, I don't really feel sad.” But again, as we talked a little bit ago about those features and symptoms of depression, it's not necessarily just a sadness, it's about mood and so many other things that go with depression. It can be helpful to talk about those specific symptoms instead of just the label itself.    I wanted to throw this in there too, sometimes I've been asked this by a number of clinicians, “How do I tell the difference between depression and grief?” The short answer is that grief doesn't come with feelings of worthlessness or guilt or shame. It's not the turned-inward type of experience, whereas depression can be turned inward. Ultimately speech-language pathologists do not need to feel like they need to be mind-reader's; they do not need to feel like, “I am not a mental health expert, so therefore I cannot ask.” We can ask about depression and depressive symptoms. We can ask ourselves, “Does this person's mood appear to influence their everyday life or their recovery?” That might be the thing that will push us forward to ask a little bit more about what their experiences are like. Helpfully, there are a couple of screening tools that are really useful for clinicians, regardless of type of clinician. One is the Patient Health Questionnaire. It's a depression scale, vaguely named. It's also called the PHQ. The PHQ is a nine, or there's also an eight, item version. They're very simple scales. They've been developed for clinical populations, so the phrasing is quite short and straightforward. They use a Likert scale and they're very well validated screening tools that are also free. I believe we're going to have the pdf of the PHQ-9, which is nine items scale, in the Show Notes.    Janet: Right   Rebecca:  Great. Another scale that's been developed specifically for aphasia, though, it's really addressing caregivers or other proxy reporters, is the Stroke Aphasic Depression Questionnaire, or the SADQ, and it's available also for free. There are a couple of different versions. Again, that's been created for people with aphasia in mind, specifically their caregivers. So that's really helpful tools. In Short, these are great tools to use, and just give us a little more information as we're having a conversation about depression. They then give us some ideas about what next steps to take, including referrals that we might be thinking about.    Janet: Rebecca, those are excellent ideas. And indeed, those two resources you mentioned will be in our show notes. You speak about depression in patients with aphasia, but I believe that depression also affects the care partners of a person with aphasia. What do you see is the role of a clinician in recognizing depression in a care partner?    Rebecca: This is really, unfortunately, true. Depression is experienced by caregivers, including stroke caregivers and aphasia caregivers, and depression symptoms align, and maybe not surprisingly, with the degree of caregiving effort that's required by the family members. In other words, caregiver depression, can be higher when caregivers are working with a loved one who has more severe functional impairment. Here are even more sobering statistics. There was a study conducted, it's a few years back, about caregiving adults, ages 66 and up, so it's a lot of our clients, family members, and spouses, etc. Those caregivers who reported mental or emotional strain had a 63% increase in mortality risk compared to caregivers who did not report strain. That's a really shocking and sobering to think about. The takeaway here is caregiving burden, as it's often called, that s just a very, very real problem with us. Given that caregivers are such an important part of our client's recovery, their health and well-being are just incredibly important. So how can we support them? They're not our primary concern, because our client is, so what do we do? What do we do for caregivers to support them? Of course, we can ask how they're doing, certainly. Then we can also provide some support resources, support groups, counseling services, and the fact that we are doing much more online now has opened up opportunities for both caregivers and clients to participate in lots of different ways, to connect virtually, and so that's great.    Another really great tool that can be used is called the Caregiver Questionnaire. It's a questionnaire that has 17 items and was developed by the American Medical Association. It just goes through a listing of common caregiver experiences that can really be illuminating for caregivers. I've given this questionnaire to caregivers in different contexts, including in caregiver support groups. What I hear from caregivers, once they go through those 17 questions, is often they're surprised. They're often not thinking a lot about how they're doing themselves, because they're very focused on supporting their loved one. It can be really illuminating for them to answer the questions and realize, “Wow, I am really fatigued I'm really tired. And maybe I need some extra support”. What I sometimes recommend to clinicians is having this questionnaire on hand and providing it to caregivers while you're working with the client, and then maybe checking in at the end of the session to say, “You know, how was that for you?” And it's an opportunity, again, to provide some support resources that they can explore on their own. I think it's a really handy way to just shine a light for caregivers, saying, ”Hey you're doing a lot, we recognize that and we know you need support, too.”   Janet:  I think that's very important. It reminds me of the message you see on the airlines, you know, put your own oxygen mask on first, so that you're better able to help the other people. If you're a caregiver, you must take care of yourself, and we must help the caregivers take care of themselves so that they can better care for our patients with aphasia.    Rebecca: Oh, my gosh, so true.   Janet:  Depression typically does not appear by itself. You've alluded to that and mentioned that earlier. In your experience and investigation. How does depression interact with coping skills, resilience or motivation? Are there other interactions that we may see in persons with aphasia?    Rebecca: Oh, my gosh, depression, part of the reason that I studied depression, among other things, is that it's a really interesting experience. It's part of a grouping of some biophysiological processes that are so intimately linked together. I hope you don't mind if I geek out a little bit here.   Janet: Geek away   Rebecca: Geek away - All right. We know that when we perceive something stressful, like, let's say we're near a potentially dangerous animal or something like that, it's classic example. It triggers systems in our body that helps us respond, right, we've heard of the fight or flight response, where our adrenaline system jacks up so that we can move quickly, right or get away from the danger, or if we have to, fight it off. Then once the danger is gone, our body goes back to its normal functioning state, the adrenal system stops pumping out adrenaline and our heart rate slows to a normal rate, all that good stuff, right? So of course, our body does pretty much the same thing when we're not in danger, per se, but we are experiencing or we perceive stress; that could be public speaking for some, or a big job interview. Then thinking about people with aphasia, maybe it's really stressful to make that phone call to somebody, even someone they know well. They don't feel confident about their communication ability, and that can be incredibly stressful. Even though it's not danger, it still can kick our body's stress systems into gear, activating that adrenal response, etc. Here's the thing, though, if our body is entering that stress state pretty regularly, it gets regularly flooded with these stress biochemicals that can impact multiple systems. We can handle those biochemicals, we were built to handle those biochemicals. But we weren't really built to handle them all the time, or often over a long period of time. If those biochemicals are circulating in our blood, they can really have a damaging effect on our body, and they have a damaging effect on parts of the brain, that are really important for us as speech language pathologists thinking about treatment, right? So those biochemicals, and cortisol is among them, can diminish functioning of regions of the brain that we need for things like attention and memory, things that are really important for learning, right? What do we do in treatment - we learn. At the same time, these biochemicals can increase parts of the brain, like the amygdala, that are really central for emotion. In other words, if we're experiencing persisting stress over a period of time, we may have impairments in memory and focus to a degree, and we may also experience depression, anxiety, and other mental health challenges. I got really, really interested in stress and depression a few years ago, and as you mentioned at the beginning, we created a scale for chronic stress for people with aphasia. Using that scale we found, just as we would in the general population, that there are very close associations between reports of perceived chronic stress and reports of depressive symptoms. The bottom line is that chronic stress is significantly connected to depression, and it's significantly experienced by our clients with aphasia.   You asked about coping skills and resilience and that's another area that I've been really, really interested in. We know that there's an association between depression and resilience, or how people cope with stress. As resilience goes up, depression tends to go down. But we also have seen that this relationship is more complex than I anticipated. We are currently validating a scale of resilience for aphasia. We really want to understand better how resilience and depression and other mental health challenges fit together, and then how we address them.   Janet:  I think that's very important work because we're, when we engage on the therapeutic endeavor, when we begin treatment, it is a partnership. And both the clinician and the patient with aphasia, but also the caregiver, we have to be in there engaged in that process and moving forward to achieve whatever communication goals we have in mind for the patient. If a patient is not engaged because of low coping skills or low resilience, because of depression, that can certainly affect our treatment,   Rebecca: Agreed. It's things that we don't really understand. I mean, we understand to a degree, for sure, but I think with some time and some additional research, we'll be able to understand much more clearly how depression and resilience impact treatment, and also how we can capitalize on resilience and build it. I'm looking forward to uncovering some of these associations and understanding them better.    Janet: Oh, I look forward to reading your work on that. I want to ask you now the next logical and perhaps obvious question, which is how may depression experienced by a person with aphasia adversely affect the treatment, as well as the quality of life in that person, and with the person's caregivers?   Rebecca: We've talked about people who have experienced depression in one way or another, and depression is really mean. It is really a mean, mean process, that can sap our interests in things that we like to do and screw up our sleep and our appetite. It impacts others around us, of course, but yes, absolutely, depression can dampen motivation. That's one of its features, it can dampen motivation to get out of the house, or for our clients with aphasia, it can diminish how much initiative they want to take with activities, especially social interactions that really help with language function and recovery. It may diminish their initiative to seek support or to reach out and start speech therapy. Then, even when a person has decided to actively engage in therapy, depression may also limit how much he or she can take away from that therapy experience to a degree, given that it's harder to attend to things, it's harder to concentrate, it's harder to remember, when you are also struggling with depression. Then it's also that all of those things that contribute to how well we can engage in treatment and adhere to treatment recommendations. We need a level of motivation and initiative and energy to tackle assignments that our therapists might have given us to work on in between our sessions. There are just multiple ways that depression could influence treatment, either through those diminished cognitive processes, or the impact on engagement, and adherence. There are just a lot of questions that we have, still about these impacts on treatment, and how they influence the outcomes of treatment.    Janet: One of the things we've observed in some work we've done recently is that people talk a lot about motivation, or resilience or coping, but people haven't yet figured out what that means or how to identify it. I'm very glad that you're doing some of this work to help us understand how we can best approach the treatment effort and really assure maximum engagement of the patients to achieve the goals that we want to achieve.   Rebecca: It is really interesting. There is some really interesting work going on in some other allied health disciplines that is, I think, helping us to pave the way in thinking about how to ask these questions about engagement. It's for our clients as well. I am excited to move forward on that.    Janet: You're right about that! Speech-language pathologists are by nature, compassionate individuals, and would be responsive to a person with aphasia or a care partner who seems to show depression. What guidance can you offer for clinicians as they plan and implement a rehab program for a person with aphasia, who shows signs of depression?    Rebecca: Oh, first of all, Janet, I agree. Speech-language pathologists are such a big-hearted bunch and that is just a real plus for our clients. There are a number of things that we can do to consider depression and treatment planning. In addition to being aware of the impact of depression, and those engagement and motivation issues, the cognitive issues, and the screening that we already talked about, we of course, can make appropriate referrals. This can be easier for some clinicians and more difficult for others. Some clinicians who work in an environment like an acute care or rehab environment, may have access to a psychologist or social worker, rehab counselor, someone like that who can help step in and provide support or other resources. For other clinicians who work in outpatient settings, the best referral might be to the client's primary care physician. Unfortunately, as we know, there are just not enough mental health professionals with aphasia expertise; we need so many more of those. That's a whole other discussion, isn't it? The primary care physician and support groups can be some of the first people that we refer to, if we are working in an outpatient setting. In addition to those things we can also provide some information and training to family members, and our colleagues and our clinical teams about supportive communication techniques. Interestingly, people with aphasia have talked about how interacting with people that know a little bit about aphasia and know how to support communication really can not only facilitate the conversation, but also help improve their mood, and give them a little boost. They also talk about how important it is to both acknowledge their experiences and perspectives and struggles, and to have at the same time, a positive outlook, to use humor, to celebrate goals. All of those things have been things that people with aphasia have talked about as elements that really help in working with clinicians and others for that matter.    Another thing that has come up, and you and I have talked about this a little bit, is also about the tremendous impact of mental health challenges for people with aphasia. We talked a bit ago about the very high incidence of depression in aphasia. And so, people with aphasia have said in previous work that they really wanted more information about low mood and changes that can come with stroke, around mood and mental health, and wanted an open forum to talk about that, and continue those conversations with caregivers as well. That open discussion about depression, about other kinds of mental health struggles, can really help normalize it, help destigmatize it so that we can address it more readily.    Janet: That makes sense. And you know, one of the key points I heard you just say is that, as a clinician, it's important for us to be aware of the community resources that are around us, whether they're specific individuals like neuropsychologists or mental health workers, or support groups or community groups. Bearing that in mind that we're not alone, as clinicians working with patients with aphasia, we have a whole group of people who can contribute to this rehabilitation effort.    Rebecca: Absolutely. And I was going to add, in addition to the myriad of people that can be around and supporting people with aphasia who are struggling with mood issues and other mental health challenges, support groups are really amazing. I would say if I gave a couple of tips for clinicians, but I had three things that I was thinking of, that we can really encourage for our clients, and one is to really seek out those support groups and other opportunities for connection with each other. I mean, I think we all know that groups can be so amazingly effective at not only providing some opportunities for social connection, but also that emotional support, and kind of perspective-checking opportunities for our clients can realize, “Oh, I'm not alone, others are also struggling in a similar way.” I'm the biggest cheerleader for support groups, as I think we all are,    This is one of those broken record things. Exercise is another incredibly, useful tool. We all know, of course, that exercise is good for our health and our cardiovascular functioning, all that good stuff. But it also so helpful in improving mood and cognitive functioning. Getting outside and moving around is just so important. There is just scads of research across many health disciplines that talks about this and reminds us about the importance of exercise.    Here's the other thing that I think is really cool to suggest to clients. And that is, in simple terms, do more of what you like to do. There's been some work around behavioral treatment approaches for stroke survivors, including those with aphasia, using a framework called behavioral activation. Thomas and colleagues in the UK have done a little bit of work around this. The basic notion is that by doing more of what you like to do, provided it's healthy and not detrimental, of course, can really help improve mood. When we do things we enjoy, it releases endorphins, and it gives us some sense of satisfaction and well-being. That's exercise for some people, not for everybody. Other people may find doing creative things, or learning something new, or engaging in something that feels like it's contributing in some way. Those can all be things that can over time, help improve mood and outlook. This can be a little challenging for folks with aphasia; the things that they think about or reach for, or things they enjoy, are maybe no longer available to them because of their language and communication impairment, or other impairments that have come with stroke. So again, the support groups are so helpful. They can be places where people have an opportunity to learn about new activities or connect with opportunities that may fill that hole of things that they like to do, new things that they hadn't discovered before. I always have more plugs for support groups.   Janet: The things that you mentioned, they're simple, they're easy, but they're so powerful. Sometimes we forget that the simple things can often have the biggest change or make the biggest change, or the biggest difference for us. It's a good thing that you have been reminding us of those things today.    Rebecca: Simple things, and sometimes combinations like a couple of simple things together can make a huge impact.   Janet: As important as the treatment techniques are to address specific linguistic and communication goals, an individual's mental health state and their feelings of engagement with the clinician and the process are just as important, as we've mentioned several times today, What advice or suggestions or lessons learned, can you describe for our listeners that will help them become better clinicians, and address the whole person in aphasia therapy, including our role as clinicians in counseling, and I don't mean the professional counseling that is reserved for degreed mental health professionals. I mean the communication counseling and quality of life communication counseling.    Rebecca: Yeah, even though speech-language pathologists are not mental health experts, there really are a number of very simple counseling skills that can help connect with our client s and more fully understand how they're doing, where are their struggles are, how are they doing in terms of mental health. When we understand them more fully, what's important to them, what they're struggling with, then it's easier to build treatment plans that fit them as individuals. So, if I'm putting on my counseling hat, I have a couple of things that I would prioritize, I think I have five, five things that I would prioritize as a speech-language pathologist using some counseling skills.    Janet: I will count them.   Rebecca: The first one is really to consider their stage post event or post stroke. If the stroke or the event is new, we may be working more with the family; they may be in shock, they may be overwhelmed and struggling to take in the information that we and our clinical team are providing to them. Those conversations differ tremendously from the conversations we might have with clients and families that are in the chronic stage, because they have a better sense of aphasia and of what it means for them, what their everyday needs are, etc. I think considering first of all, the stage post stroke or post event is really important.    The second thing I would say is to find empathy and unconditional positive regard. It is good to know that depression is complicated, and it can come with emotions, a lot of different emotions and experiences from anger and frustration and shame, and so sometimes our conversations around depression can be uncomfortable. I would say, approach these conversations in an open and honest way about the client's challenges and maintain that unconditional positive regard even when we're feeling that discomfort ourselves. If they are angry and frustrated, we also may feel angry and frustrated or defensive or something else that doesn't feel very good as clinicians, or for anybody for that matter. Just remembering that unconditional positive regard, that we really all want the same thing. We want improvement. We want improvements in life and to face things like depression and find some answers that will really help push clients forward.    The third thing that I would say is giving clients and family members our full attention and listen really actively and carefully. Sometimes this can be just an extra 30 seconds, an extra 60 seconds of listening using some reflective techniques that can really provide some critical information about our client, their needs and priorities that we can use in treatment planning. At the same time, this act of listening very deeply, and reflectively can help build our connection with their client and that's going to help promote engagement, adherence, and trust, which is just so essential for the therapeutic alliance.    The fourth thing I would say is communicate multi-modally. I would say this not just for clients, but for family members as well. I myself have been the caregiver in situations where a clinician, never an SLP I will say, has come in and talked to a loved one and it was wasted words and time because nobody could take in that information. It was feeling overwhelmed and that that information might have come in as just some noise; maybe we remember one or two words from it and couldn't take the rest of it away, just given everything else that we were processing in that moment. I always say, never just say something, say it and write it or diagram it. This is just again, so important with clients and families who are stressed, who are depressed or anxious in some way. It is just so hard to remember when we're feeling overwhelmed. We can really support our clients and families by communicating in a multi-modal way. Even almost as important as summarizing what we've said and providing information again, I had a caregiver once say never tell us more than three things at once, because the fourth thing is going to be lost. I took that to heart; I understand that that makes perfect sense. And of course, providing a lot of opportunities for questions is helpful. That number four had a lot of pieces to it.    Here's number five, and this is really obvious, developing mutual goals with our client and revisiting them. Sometimes when our client is struggling with depression, we might find their treatment plan seemed like a great idea, seemed like a great fit for our client, and just falls flat. If our client is really struggling to concentrate or engage in an activity because of depression, it just makes sense to stop and revisit those goals and make sure they really line up with the client's interests and priorities, but also how they're doing and how they're able to engage given everything else that's going on - mental health-wise and otherwise.    Janet: Those are five excellent tips, Rebecca, excellent. And again, they're not difficult things to do, but they're so important, especially if you do all five of them together. I think our listeners are going to be quite pleased to learn about these five ideas that you have.    Depression experienced by persons with aphasia is not new, we've talked about this earlier, certainly as long as there has been aphasia, there have been people with aphasia and depression. But although it's not new, it has not been well recognized or really well studied, as you mentioned earlier on. During the past year, as a result of changes due to the pandemic, such as the stay-at-home orders, limitations on in-person activities, and the increase in virtual care, I believe depression and associated mental health and self-care concerns have increased and have come to the forefront of our thinking. Have you found this to be the case?   Rebecca: It's interesting. We are in the midst of a study right now, that's looking at how our research participants are doing during the pandemic as compared to pre-COVID, pre-pandemic. We're not done, we're midway through, but so far, we're seeing some really interesting challenges that people are reporting with everyday functioning during the pandemic, which it doesn't surprise us, of course, we're all struggling with functioning, I think, during the pandemic. We're not necessarily seeing greater levels of stress for the group we've done so far. Some people are reporting more stress, and some people are reporting less, which is fascinating. I'm going to give you some examples. Some people have said that they're not really that bothered by not being able to leave the house. Then other people are talking about how they're not able to do the things that they've always done, and that's been really difficult and stressful for them. So clearly, there's a lot of variety of experiences that we've heard so far. I'm really looking forward to finishing up that study and just looking at all the data together. Maybe the next time we talk we'll have some better news or a clearer picture about what people's experiences are like.    Janet: I'll look forward to hearing about that.    Rebeca: Separately, a couple of months ago, we chatted with our friends with aphasia and just asked, “Hey, what's been helping you during these lock downs, during this time of isolation?” And here's what they said: they said things like games and puzzles and dominoes were helping; listening to music every day. One person found brain teaser books were helpful and fun right now; several people were cheering for support groups that they were attending online; playing with pets; connecting with family over FaceTime. One person talked about chair yoga. Those are the things that our friends with aphasia are doing that they say are really helping.    I think we're all thinking about self-care right now. It's just so important, of course exercise and getting outside and learning something new. I think we've all heard of countless people that have learned to bake bread this year, me among them. Taking care of things like a new plant, and then just finding ways to connect with each other, though a little bit different than we were doing it before.    Janet: That is so true. I think we've all been finding those new ways and new things and new ways of connecting with people. Rebecca, you've given us much to think about today. Depression may not always be easy to recognize in an individual, and certainly its management is multifaceted. As we draw our conversation to a close, what are some words of wisdom that you have to offer to our listeners who interact with persons with aphasia every day? And who may be wondering, “How do I start a conversation about depression with my clients, or my clients’ caregivers?”   Rebecca: I would say first, be yourself, be genuine. When we are able to genuinely connect with our clients and their families, it really does strengthen the trust, and build our relationship for some good clinical work together. Then ask about depressive symptoms, as we've talked about before, and communicating openly about depression; not something that we should, you know, hide away, but actually discuss and regularly check in on, as well as providing some resources and support for what to do when someone's feeling depressed or struggling with mental health. Then listening fully and acknowledging the experiences of our client, the good stuff, the difficult stuff, all of it. They're really the experts on life with aphasia and they are such a critical part of our clinical decision making. Then keeping our eye on the literature as there is more clinical research on depression, and other psychological challenges in aphasia right now than I think ever before, which is incredibly exciting. So just keep an eye on that. And then I think this is a really important one - take care of yourself. Clinicians working with people with communication disorders are also experiencing depression. It can be a lot over time, and no one can be a great clinician if their own health, their own well-being is compromised, so do what you can to take care of yourself. Again, simple things, several simple things we can do to just make sure we're our most healthy and going to be the best supporters for our clients and their families.    Janet: Those are some very, very good suggestions. If I'm right, you have a paper coming out in Perspectives soon, about counseling skills, is that correct?    Rebecca: Yeah, there should be a paper coming out soon about counseling skills, and also about stages using those skills, depending on the stages post event or post stroke, hopefully, that'll be coming out really soon.    Janet: This is Perspectives for the Special Interest Groups within the American Speech-Language-Hearing Association. I have to say, I remember, oh gosh, many, many years ago, I wrote a paper for Perspectives on depression and aphasia, and at that time, there was not very much written about it; people were thinking a little bit more about quality of life. As I reread that paper before talking to you today, I found myself thinking how much more information is available now, how much more in the forefront is the topic of depression, and mental health and psychosocial skills, and how pleased I am that there are so many people who are really recognizing the importance of having these conversations with our clients and caregivers.   Rebecca:  I'm so glad that there's more available now, but I have to say thank you, Janet, for blazing that trail those years ago, you have been an inspiration clearly and I'm glad that we are picking up the pace on these important topics.   Janet:  And you indeed are. This is Janet Patterson and I'm speaking from the VA in Northern California, and along with Aphasia Access, I would like to thank my guest, Rebecca Hunting Pompon, for sharing her knowledge, wisdom, experience and guidance about this most important topic, the effect depression can have on persons with aphasia, and their care partners.    You can find references and links and the Show Notes from today's podcast interview with Rebecca, at Aphasia Access under the Resources tab on the homepage.   On behalf of Aphasia Access, we thank you for listening to this episode of The Aphasia Access Conversations Podcast. For more information on Aphasia Access, and to access our growing library of materials, please go to www.aphasiaaccess.org. If you have an idea for a future podcast topic, please email us at info@aphasiaaccess.org. Thank you again for your ongoing support of Aphasia Access.   Links and social media Lab website: UDAROLab.com Facebook: “UD Aphasia & Rehabilitation Outcomes Lab” AMA Caregiver Self Assessment Questionnaire (free pdfs; 5 languages): https://www.healthinaging.org/tools-and-tips/caregiver-self-assessment-questionnaire   Citations Modified Perceived Stress Scale: Hunting Pompon, R., Amtmann, D., Bombardier, C., and Kendall, D. (2018). Modification and validation of a measure of chronic stress for people with aphasia. Journal of Speech, Language, and Hearing Research, 61, 2934-2949. doi.org/10.1044/2018_JSLHR-L-18-0173   Patient Health Questionnaire depression scale (PHQ)  PHQ9 Copyright © Pfizer Inc. All rights reserved. Reproduced with permission. PRIME-MD ® is a trademark of Pfizer Inc. (open access)   Stroke Aphasic Depression Questionnaire (SAD-Q) https://www.nottingham.ac.uk/medicine/about/rehabilitationageing/publishedassessments.aspx  

The 4M's Framework: MENTATION with Tahira I. Lodhi MD "Mentation is about preventing, identifying, treating, and appropriately managing the 3Ds in geriatrics: dementia, delirium, and depression."-Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN “She’s just not right today”. When referring to an older adult, this simple phrase should be a signal to family and formal caregivers alike to begin to find out why.  If a child “wasn’t right” one day, no one would ignore it - and we cannot ignore it in an older adult. An altered mental state is a broad term for geriatric patients having issues with their cognitive level. Essentially, for older adults with altered mental states, early detection and diagnosis are essential, as the source could be life-threatening.  In line with that, today's episode of This Is Getting Old, will focus on continuing our special series on the Health Systems Initiative and the 4Ms Framework, explicitly talking about MENTATION.  Dr. Tahira I. Lodhi joins us, and we'll talk more about providing health care services to older adults with the limelight on the spheres of Mentation. Also check out these related podcasts: Ten Warning Signs of Dementia Six Tips for Talking to Someone You Think Has a Memory Problem How Dementia is Diagnosed Ten Tips for Preventing Alzheimer’s Disease How to Manage Repetitive Behaviors in Alzheimer’s Disease Part One of 'The 4M's Framework: MENTATION'. THE SPHERES OF MENTATION Mentation is about preventing, identifying, treating, and appropriately managing what is referred to as the 3D's in geriatrics; dementia, delirium, and depression. The 3D's are a cornerstone of geriatrics, and it can be challenging to tease these three apart when providing care to an older adult.  There are several characteristics in common with depression, dementia, and delirium. Apathy, detachment, and tearfulness can be present in both depression and delirium, especially hypoactive delirium. However, a reliable indicator lies with the onset and duration.  The onset of dementia is slow and insidious. However, deterioration is progressive over time. Delirium develops unexpectedly (for hours or days), and manifestations appear to fluctuate during the day. While a change in mood persisting for at least two weeks characterizes the onset of depression. The duration may coincide with life changes and can last for months or years. DELVING DEEPER INTO MENTATION DEPRESSION It is necessary to remember that depression is not an unavoidable aspect of becoming older, nor is it an indication of failure or character defects. Regardless of your history or past successes in life, it can happen to everyone, at any age. While life changes when you age, retirement, loved ones' demise, deteriorating health may also induce depression.   TOOLS FOR ASSESSING DEPRESSION For health care providers, it's essential to recognize depression. You can use several instruments, like PHQ-2, PHQ-9, and other Geriatric Depression Scales, to assess depression in older adults.  PHQ-2 (Patient Health Questionnaire-2) uses a valid and reliable depression screening tool for all ages. In comparison, a PHQ-9 is a screening test that can also be used to follow-up on a promising PHQ-2 outcome and to track response to therapy. "You may find that a person who was once active in the long-term care setting is now just sitting on the sidelines, not talking to anybody and say that they just feel down. That's the time to evaluate the person and make sure it's not depression." -Tahira I. Lodhi, MD SIGNS AND SYMPTOMS OF DEPRESSION IN OLDER ADULTS Recognizing depression starts with getting familiar with the signs and symptoms. Red flags for depression include: Sadness or feelings of hopelessness. Unexplained aches and aggravated pains Lack of interest in hobbies or socializing. Loss of weight or appetite. Feelings of desperation or helplessness. Lack of encouragement and energy. Sleep disruptions Slowed movement or discourse. Fixation on death; suicidal thoughts. Problems with memory. Neglecting personal treatment   WHAT TO DO: PREVENTIVE MEASURES AS FAMILY MEMBERS OR CAREGIVERS   To help older adults suffering from depression, you can evaluate psychological evaluation with or without starting SSRIs. Selective serotonin reuptake inhibitors (SSRIs) are prescribed for patients with mild to severe depression who initiate psychiatric treatment with an antidepressant. Among the countless antidepressants, SSRIs provide as much value in terms of efficacy and mitigating health risks.  Besides, SSRIs are the most commonly used antidepressants. Daily exercise can even help avoid depression and lift an older adult’s mood. Let them do everything that they want to do. Also, being physically healthy and consuming a healthy diet will help reduce ailments that may contribute to depression among older adults. Moreover, Psychotherapy, often referred to as "talk therapy," can help those with depression. Talk therapy is used to mitigate depression, and it works by assisting older adults to do away with harmful thoughts and any habits that could exacerbate depression. Part Two of 'The 4M's Framework: MENTATION'. DELIRIUM Delirium can be a medical urgency/emergency and can present as either hyperactive or hypoactive. Any sudden change in mental status should be considered delirium. The hallmark is in-attention. It can get tricky when a person already has a diagnosis of dementia - we refer to this as delirium superimposed on dementia. However, once we fix the delirium's underlying cause, the person will typically return to the baseline mental status. If you or a loved one are planning an elective surgery, be sure to review these considerations and discuss them with your provider and surgeon, in hopes of preventing postoperative delirium. Page 24 has a checklist of things that you and your provider should look for and many of the Confusion Assessment Methods (CAM), such as the CAM-ICU (p. 47). RECOGNIZING HYPOACTIVE DELIRIUM  AND HYPERACTIVE DELIRIUM Delirium progresses gradually, and the effects fluctuate throughout the day and worsen at night.  Hyperactive delirium is distinguished by Increased muscle movement, restlessness, anxiety, hostility, roaming, hyper-alertness, hallucinations, delusions, and inappropriate behavior.  On the other hand, Hypoactive delirium is characterized by reduced muscle movement, lethargy, withdrawal, drowsiness, and sleeping too much. SCREENING TOOLS THAT CAN BE USED TO ASSESS DELIRIUM Whether you're a family or caregiver of older adults at risk of or healing from delirium, you should take precautions to enhance the well-being of the individual better.  Assessment tools that may be used to test instances of delirium. Confusion Assessment Method (CAM) CAM-ICU for intensive care units 3D-CAM for medical-surgical units bCAM for emergency departments WHAT TO DO AS FAMILY MEMBERS The best thing you can do as a family member is to provide encouragement and orientation.  Remind the individual where they are, who they are, and also what time it is. It would also help if you alerted providers whenever delirium signs and symptoms are noticed in the patient. A matter of saying, "Mama just isn't right today." can make a difference.  WHAT TO DO AS PROVIDERS: PREVENTION STRATEGIES As a healthcare provider, you will play a critical part in having a positive and comforting presence during an older person's delirium.  Here are several straightforward steps to alleviate delirium and how you can help as a caregiver : Convey and resolve sensory disability. Use simple sentences to ask individual questions, and use interpreters where available. Minimizing the confusion of the patient. Place a large-font clock, calendars, and signs. Promote cognitive enhancement, such as learning about news or recalling. Discourage napping throughout the day to help the patient relax at night. Foster mobility and self-care Promote autonomy in everyday life tasks and minimize the possibility of crashes. Encourage patients to reduce the possibility of constipation, dehydration, and under-nutrition by eating and drinking. Consider calming, music, or massage therapies (this may also help with sleep). Stop using indwelling catheters because they can cause contamination. It is advised to minimize, stop or prevent the usage of psychoactive medications as they can aggravate delirium. Document the indications in the psychiatric background of the patient for the usage and stopping use of antipsychotic treatment Ensure that pain control is available and that a protocol for pain treatment is in effect. Keep the room silent, such as utilizing vibrating pagers instead of calling bells. "Recognizing delirium is the biggest thing. In some of the studies that I've seen, up to 60 to 75 % of health care providers don't recognize delirium." -Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN DEMENTIA RECOGNIZING DEMENTIA Dementia is not a particular illness; it's a broad concept that encompasses a wide variety of serious medical issues, including Alzheimer's disease.   Abnormal brain shifts are triggered by diseases clustered under the general word "dementia." These transitions cause a reduction in reasoning skills, which are incredibly severe to affect everyday life and autonomous functioning. They also influence actions, thoughts, and relationships. Check out these related podcasts to learn more: Ten Warning Signs of Dementia Six Tips for Talking to Someone You Think Has a Memory Problem How Dementia is Diagnosed Ten Tips for Preventing Alzheimer’s Disease How to Manage Repetitive Behaviors in Alzheimer’s Disease SCREENING TOOLS USED TO ASSESS DEMENTIA A clinical evaluation, experimental testing, and the observation of the irregular shifts in thought, day-to-day function, and patient actions are needed by physicians to identify Alzheimer's and other forms of dementia.  But the precise form of dementia is more difficult to ascertain since the signs and brain alterations of multiple dementias may overlap. For health care providers, some of the screening tools that are commonly used are MMSE (Mini-Mental State Exam), MoCA (Montreal Cognitive Assessment for Dementia, and the SLUMS Test. WHAT TO DO AS FAMILY MEMBERS AND HEALTHCARE PROVIDERS You can take measures to improve cognitive health and reduce your loved one or patient's risk of dementia. Please encourage them to maintain an active mind by playing word puzzles, memory games, and reading. Being physically active, exercising at least once a week, and making other positive lifestyle improvements will also lower the risk. Lifestyle and dietary improvements include avoiding smoking and consuming a diet high in, Fatty Acids omega-3, Fruit, Vegetable, and whole grains.    About Tahira I. Lodhi MD  Tahira I. Lodhi, MD, is an assistant professor at the University of George Washington for Geriatrics and Palliative Care. In 1999, she graduated from medical school and received her Family Medicine training at Virginia Commonwealth University and her Geriatrics Fellowship Training at George Washington University. Dr. Lodhi's expertise is in the training and practice of primary care geriatrics. She's often involved in developing workflows in healthcare systems and supporting her patients to receive streamlined, patient-centered services.     About Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN]:   I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.  

Good Morning Veterans, Family, and Friends, and Everyone who has returned back to listen in on the SIXTH EPISODE of the Veteran Doctor. On this week's podcast, we will discuss More New Year’s Resolutions for Veterans and dig into the topic of Veteran Suicide. We have also will continue to fun facts with our section on UBI (Useful Bits of Information) and Veteran News. Later I will also be discussing my New Book that is coming out soon, My Veteran Blog, and the Podcast Patron/Sponsorship Program, so stick around for so great stuff to come. Welcome back to another month of fun and festivities. I hope the holidays have treated you well. Every year we get to this moment when we tell ourselves we are going to change some things in the coming year to better ourselves. The resolutions, or goals, are often not obtained due to lofty tasks and not being carefully thought out or planned in how they will be executed; like that of a military mission. Some common resolutions that many veterans look to achieve are categories of health, financial, mental health/happiness, and sharing or helping other veterans. I will look deeper into these goals to see if any of these things interest you as a focus of self-improvement in your upcoming year. Health Military veterans have always been healthy-minded individuals that have usually placed it as an essential part of their lives. It is expected that as the years' pass, many veterans forget about their previous military fitness regimens. Unfortunately, aging and life impact us all, but it doesn’t have to be quite so brutal if we take care of ourselves through exercise and eating right. Remember back when you started basic training, and you made (or were forced) to make a resolution to create a healthy routine. This does not mean you have to do 1000 pushup and sit-ups in the middle of the hot sun, but instead, you should start small and build up from there. Vow to make your health and fitness a priority in your life and a part of your daily routine. It is hard to resist the healthy feeling you will have when you are currently ill and overweight from an inactive lifestyle. So ultimately, set a small, realistic goal. Even if you just start walking 15 to 20 minutes a day, then built up from there in moderation, it will be worth it in the end. Do it for yourself. You will find that you will start feeling better and have more energy if you eat right and start taking better care of yourself. Financial Taking care of your body is only one part of the equation; taking care of your wallet is another part. This is an area that is sometimes very difficult for many people. Not everyone has the ability or luxury to save money, but there are a few simple things that you can do with your money to make it stretch further. Finding coupons is an easy way to save your hard-earned cash. Many people do not realize that coupons are everywhere, like the daily newspaper and even online, that applied to nearly every type of purchase. Another way to save more money is through Groupon. This resource allows you to save a lot of money in Las Vegas. Spending time to look up coupons online can save you thousands of dollars a year. There are also many discounts throughout the Las Vegas area as long as you research and ask. If they say “no,” then say respectfully “thank you.” It doesn’t hurt to inquire about a military discount. There are more discounts out there than you think. Some very recognizable ones are Vettix.org. These are free concerts, shows, and event tickets for veterans. Another benefit for veterans is Free National Parks Pass for veterans at www.nps.gov/planyourvisit/passes for free passes to any national park-like Lake Mead. Another great local resource is lv.houseseats.com to great show seats for local Las Vegas shows. There is a nominal fee for the annual membership, but it is well worth the cost and pays for itself upon the first use. Take the extra time to search for savings, and your wallet will thank you. You will also have fun too. Mental Health / Happiness This should be the easiest one, but for many, it is not. For veterans suffering from PTSD, or poor Mental Wellness, finding happiness can often be extremely challenging. A large percentage of veterans in the United States continue to struggle with the symptoms of post-traumatic stress disorder (PTSD), while society continues to look for ways to help these heroes. PTSD is diagnosed as being a mental health issue that results from having experienced or witnessed traumatic events and can result in symptoms of severe anxiety, depression, hypervigilance, insomnia, agitation, flashbacks, isolation, and other harmful side-effects. PTSD can debilitate a veteran's work, family, and social life to a level of being nonfunctional. Unfortunately, PTSD can be linked to the high suicide rate for U.S. veterans. Recent studies by the VA estimate that 20 veterans commit suicide every day. Even though veterans represent only 9% of the population, they make up 18% of Americans who commit suicide. Society has begun to recognize that the U.S. veteran population needs help overcome the residual effects of war. Many times, some veterans need to know that there are many similar people out there that have traveled, and made it through, similar experiences of PTSD. A person living with PTSD never knows when a flashback might occur, or when something may trigger the memories, and what the physical reactions may be. Sometimes keeping up a happy appearance during the bout of depression can be just as exhausting and too much to handle as the original traumatic experience. There is a wide range of 24-hour veteran crisis hotlines available for veterans who find themselves seriously struggling with these challenges. Any veteran can call toll free: 1-800-273-8255 and press “1” to reach someone immediately through the VA’s crisis line; their website also has confidential online chat and text options, as well as help for veterans with hearing impairment. In many cases, just allowing veterans to talk through your emotions or mental state can release them from the moment, and knowing that they are not alone can give them the strength they need. Sharing and helping other veterans Many veterans have an innate sense of duty to help other people. Why not help other veterans or share your time if you sense they are lonely. Take up a new indoor or outdoor hobby with them. Some veterans who are experiencing specific symptoms of PTSD – repetitive thoughts, racing mind, sensitivity to certain trigger noises, anxiety from being in crowds – can benefit from the peace acquired from hobbies. There is a wide range of hobbies and organizations that solely exist to help give veterans the chance to learn a new activity to quiet and heal the mind. Another great way of sharing is getting involved with dog adoption agencies that are involved with veterans. Dogs help offer the benefit of companionship without any judgments or expectations to veterans who are challenged with the isolation and irritability from PTSD. Dogs are naturally vigilant and help remove that anxiety from a veteran who is experiencing difficulty with sleep. Most pets enjoy giving, receiving affection, and are naturally soothing. Dogs also are dependent on their owners, making them the main reason for a veteran to hold on, knowing they need to care for their pet in the future. Whether a veteran requires a highly-trained dog that can detect and react to signs of severe PTSD or a simple companion dog that is always there to hang out, there are specific programs that can help veterans, typically at little or no cost. This year, we need to resolve to help one another find the happiest of times. If you know a veteran who is suffering from loss or mental health issues, get help immediately. Every day is precious and being mentally fit and happier is imperative. Sharing this information can also bring joy to others. If you know a veteran that needs some extra attention, help them out. Extending a helping hand, or paying it forward, makes the world a better place, and brings happiness to the heart. Hopefully, this past year has brought you some great fun and memories. I hope and wish that the upcoming year will bring even better ones. Have a happy, healthy, and prosperous New Year. Veteran Suicide – A Very Real and Serious Issue For nearly a decade, the veteran community has called for action by our nation’s leaders to respond to the 20 veterans a day suicidal rate. The issue of veteran suicide is now its conversation in media coverage, national conversation, and a surge of government support. Yet, the problem of suicide continues. According to recent VA data, post-9/11 veterans between ages 18 to 34 have the highest rate of suicide. Though not always an indicator of suicide, mental health injuries continue to impact the post-9/11 generation. Surprisingly, 65% reported PTSD, and 58% anxiety, and 56% depression. The nation and VA continue struggling with mental health care and providers’ demands, two of the top VA staffing shortages. There has been some progress. In mental health injuries, 3 in 4 are seeking care for their injury. Over the past few years, increased progress has been made in the realm of suicide prevention and mental health. The VA’s plan for transitioning veterans’ targets those in the post-9/11 population as an increased risk of suicide and engage them before the moment of crisis. The VA has leveraged telemental health care to expand its reach and predictive analytics to target the top 0.1% of veterans at risk for suicide. According to a recently released report by the Department of Veterans Affairs veterans’ suicide rate ticked upwards recently despite increased public attention and funding on this problem. However, the latest data still does not represent the present conditions. According to mental health experts, this ongoing coronavirus pandemic may cause larger increases in the rates of mental distress and self-harm among veterans. Approximately from 2005 to 2018, the overall suicide rate has remained mostly unchanged, between 17 and 18 veterans a day. This rate is about 1.5 times that of the civilian population, according to the Department of Veterans Affairs (VA). Among veterans, suicide rates remain about the same as the civilian U.S. population, but both are rising. Recent studies have announced that 325 active-duty members died by suicide in 2018, 40 more than in 2017, which has been the highest number since data started to be collected in 2001. Nobody knows why suicide rates continue to climb. Numerous public figures and awareness campaigns in recent years have quoted the figure of “20 or 22 a day” in reference to veterans’ suicide, but VA officials clarified that this estimate includes active-duty troops, guardsmen, and reservists. Many fault demographics—85 percent of the veterans are male, and men die by suicide more often than women. But we also know that even female veterans die by suicide at a higher rate than civilians. In the 2019 VA suicide prevention annual report, women veterans’ suicide rate was 2.2 times greater than that of civilian women. In addition to the demographics, factors of insomnia, depression, anxiety, sexual victimization, gun ownership, and substance use disorders also appear to contribute to suicidal risk. Older veterans also cope with aging, stress, or lingering effects of their military service that has never been addressed from the past, while many recently discharged veterans seem to have trouble with their relationships or transitioning challenges back to civilian life. Now, psychologists within and outside the VA are leading efforts to improve suicide risk assessment and research to better understand and prevent veteran suicide. They are also developing and piloting interventions at both individual and community levels to respond to this deadly issue. The recently released figures show that veterans who have died by suicide in 2018 were 6,435, up less than half a percent over the total veterans’ population. By comparison, there have been 7,032 troop deaths in conflict zones since 9/11, according to Defense Department statistics. Veterans suicides made up approximately 14 percent of the total suicides in America in 2018. In recent years, VA officials have emphasized that mental health challenges and suicidal thoughts are not specific to the veterans’ community. Findings highlighted the increasing problem of suicide among U.S. civilian adults and veterans and the need for suicide risk mitigation efforts. Despite the lack of general progress in suicide prevention among veterans, some improvements have been occurring. Data shows that the rate of suicide among veterans who have used VA health services has decreased, and it is an encouraging sign that the department continues to learn as its works and cares for veterans. The suicide rate among veterans who receive VA care has decreased by about 2.4 percent from 2017 to 2018. Data has shown that suicide is indeed preventable through clinical and community-based prevention interventions, along with research and surveillance within the VA. Although this report explains that suicide is preventable, suicide prevention is exceptionally complex. Recently, Senate lawmakers passed a package of nine VA-themed bills to improve the department’s suicide prevention efforts. However, new incentives for the safe storage of firearms among veterans were proposed. A VA suicide report shows that firearms were involved in more than 68 percent of veterans suicides in 2018 compared to 48 percent of the rest of the American population. A recent statistic has been widely quoted in the veteran community that highlights “22 veterans a day” committing suicide. It is a profoundly troubling statistic and has galvanized the veteran movement, both from inside the veteran communities and outside, to bring about a wide range of programming nationwide. The statistic, however, is widely misrepresented and misunderstood. This statement — 22 veterans a day commit suicide — while widely advertised by politicians, media outlets, veterans service organizations comes from the VA’s 2012 Suicide Data Report, which examined the deaths of 21 states from 1999 to 2011. The report found that the estimated number of veterans was compared from a sample number of states, and evidence was uncertain in veteran identifiers on U.S. death certificates. An example shows that veteran suicides’ average age was nearly 60 years old, not representative of the Iraq and Afghanistan veterans’ generation. A more current study surveyed 1.3 million veterans discharged between 2001 and 2009, discovering 1650 deployed veterans and 7703 non-deployed veteran deaths. Three hundred fifty-one of those were suicides among deployed veterans, and 1517 were suicides among non-deployed veterans. So, over nine years, there was one veteran suicide a day. Although veterans have a suicide rate 50 percent higher than those who have never served, the rate of suicide was slightly higher among veterans who never deployed, which suggests that these causes extend beyond the trauma of war. Coming home from war or merely transitioning from the military can be difficult. Various state and federal systems are set up to deal with this transition, how, ever cannot meet the need. Many people think that Veterans Affairs benefits programs like medical care, the G.I. Bill, the VA Home Loan, etc. are not helpful; however, they are. But, for the current generation of veterans from Operation Iraqi Freedom and Operation Enduring Freedom, the suicide rate is closer to probably one a day and most likely occurs within the first three years of return. While this is still very troubling, it definitely is not 22. Although additional steps are needed to bridge the gap created by those who serve and those who have not, providing support for veterans to integrate back into their families and communities requires robust public-private partnerships. The veterans and the communities they live in are both responsible for bridging these gaps. The challenges of adjustment to transition, post-traumatic stress (PTSD), traumatic brain injuries (TBI), and physical disabilities need to be addressed mainly as these things result in barriers in education, health care, employment, and overall individual well-being. Overall, the majority of these needs are being met by combining different veteran-serving nonprofits and VA support; however, many veterans do not know how to navigate this process. Unfortunately, there are still visible gaps in the system. The veteran advocacy community needs to tailor our programs, especially in preventing suicides, to respond to this concerning data. One suicide is one suicide too many. Effective programs to help service members, veterans, and families transition to a positive life after service are necessary. Another requirement is promoting supportive community relationships for veterans. We need to be developing programs specifically to address veterans’ needs while maintaining preventative care for recently returned veterans. As veterans, we all pride ourselves on not making an emotional decision but the right decision. We should have the same commitment with veterans, which means we need to act within the framework of facts — advocacy and programming. Inadvertently, we are preying on a well-intentioned public by citing a misleading statistic to receive financial support, and that is not right. As veterans, we are far more resilient than we give ourselves credit. If we do our jobs and extend a helping hand to our fellow veterans, we can reduce that suicide rate and ensure our fellow veterans avoid despair in the future. Screening and Evaluation Expansion The VA started a universal screening for suicide risk in all primary-care settings beginning in October 2018 and has conducted over 3.8 million veteran screenings for suicide. The screening protocol has three parts: The first part consists of primary screening for suicide risk using the Patient Health Questionnaire-9, typically conducted by a registered nurse. If that screening indicates a positive result, the nurse will handoff the veteran to the primary-care provider to conduct a secondary screening utilizing the Columbia-Suicide Severity Rating Scale. If that screening is positive, then a comprehensive suicide risk evaluation is conducted by the primary care provider. Another strategy deployed by the VA to help identify veterans at risk is REACH VET, a computer-based statistical risk algorithm that flags veterans based on their electronic health records. The program aims to identify and allow for preemptive care and support for veterans, usually before an individual even develops suicidal thoughts. Once a veteran has been recognized by REACH VET, the veteran’s VA mental health specialist calls to check up on them and conduct an additional evaluation to help determine any enhanced care is needed. Promising interventions After veterans at risk for suicide have been identified, the next step is to offer effective interventions. Over the past ten years, researchers have found that cognitive-behavioral therapy (CBT) can reduce suicidal thoughts and behavior for veterans at risk. But limitations of these psychotherapy approaches is that they require multiple sessions and are not easily implemented. To get more direct care to these patients, a 20- to 40­-minute intervention called the Safety Planning Intervention, designed to provide veterans with different coping strategies, reduce access to potential suicide methods like firearms and lethal medications, and help them establish follow-up treatment. The research found that veterans who received this intervention were 45 percent less likely to attempt suicide with a safety plan in place for veterans. Other promising VA suicide prevention interventions focus on technology to help patients at risk for suicide. A smartphone app has shown success in increasing the veterans’ coping abilities with unpleasant thoughts and emotions. The Virtual Hope Box app is modeled after CBT methodology that uses a physical box containing images that remind patients of positive experiences, people who care about them, reasons for living, or coping resources. Users can upload personal photos, videos, songs, and quotes; complete relaxation exercises, puzzles, and guided meditations; additional tools include coping mechanisms, including self-created cards and a phone contact list. One of the essential aspects of suicide prevention among veterans is ensuring ongoing access to mental health care is available, particularly during transition times, when suicide risk can be higher. A unique way the military is working to ensure veterans have constant access to quality mental health care through its inTransition program, which offers expert coaching and assistance to find a new mental health provider for veterans. The program was created to ensure a good handoff between mental health providers when veterans are transitioning. During the initial months after separation from the military, there is an increased risk to psychological health. That is why inTransition targets service members receiving psychological care in the 12 months before their military transition. All veterans are eligible for the program, and inTransition will find any local veteran care, even in the absence of VA. Even though the program is new, results are beginning to show successful increases in the veteran transition to new mental health providers. Focusing on lethal means safety While much of the VA’s efforts around preventing suicide focus on identifying and treating mental health issues, some experts point to the preventative measure surrounding firearms. Research shows that around 70% of military suicides involve firearms, compared with approximately 50% of suicides in the U.S. general population. The military is more likely to own firearms and knows how to use them and that they are more likely to use firearms for the purpose of suicidal behavior as compared with the general population An example can be shown that the firearm storage practices of more than 1,600 active-duty personnel from 2015 and 2018 at military primary-care facilities across the U.S. They found that nearly 36% of participants reported owning a firearm, but less than a third of those said their firearms were safely stored. About half indicated their firearms were not safely stored. More effort is needed to encourage veterans to keep their firearms safely. Findings from nonmilitary populations suggest this is an additional way to reduce suicide risk. Locking up a gun will not prevent an argument with a spouse or overwhelming stress, but it could reduce the likelihood of these circumstances resulting in death. The Veterans Health Administration is educating clinicians about the importance of asking veterans about firearms and whether they are safely stored, educating veterans about having friends restrict their firearms access during stressful times. Using communities as support Psychologists are looking for ways to prevent military suicides by looking for outside of military solutions. According to the 2019 National Veteran Suicide Prevention Annual Report, the suicide rate of veterans receiving recent VA care increased by 1.3%, while the suicide rate among veterans who were not receiving current VA care increased by 11.8%. Another effort to provide a greater understanding of the role that communities play in their prevention of suicide is Operation Deep Dive. The study examines the community-based factors involved in suicide among veterans. It has developed a “sociocultural death investigation” tool to be used by researchers to conduct interviews with family members, colleagues, and friends of deceased veterans to better understand the lives of veterans who recently died by suicide. The goal is to identify the opportunities of prevention before a veteran enters any suicide situation. Operation Deep Dive ultimately looks to where the community might have prevention points to divert an individual on the trajectory to suicidal death. Hopefully this information has increased your knowledge on this serious social issue. If you a veteran in need or you know of a veteran who needs help please use the information below to help them. Veterans experiencing any mental health emergency should contact the Veteran Crisis Line at 1-800-273-8255 and select option 1 for VA staff personnel. Veterans or their family members can also text 838255 or visit VeteransCrisisLine.net for assistance.   References: Bare, S. (2015). The Truth About 22 Veteran Suicides A Day. Task and Purpose. Retrieved From https://taskandpurpose.com/support/truth-22-veteran-suicides-day/ Novotney, A. (2020). Stopping military and veteran suicides. American Psychological Association (APA). Retrieved from https://www.apa.org/monitor/2020/01/ce-corner-suicide Shane, L. (2020). Suicide Rate Among Veterans Up Again Slightly Despite Focus on Prevention Efforts. Military Times. Retrieved from https://www.militarytimes.com/news/pentagon-congress/2020/11/12/suicide-rate-among-veterans-up-again-slightly-despite-focus-on-prevention-efforts/ Image provided by Bare, S. (2015). The Truth About 22 Veteran Suicides A Day. Task and Purpose. Retrieved From https://taskandpurpose.com/support/truth-22-veteran-suicides-day/

After working at a Veterans Affair Medical Center, hear how our guests moved into the field of emergence delirium: "upon emergence our patients were swinging and very aggressive ... there must be some way to prevent this". This fascinating piece enjoys an engaging discussion about an important topic for both patients and practitioners; how important is it for you to know a patient may suffer from post traumatic stress disorder? Do different anesthetics promote or avoid emergence delirium? Can emergence delirium cause further long term trauma? How do we deal with US military veterans specifically? Patient Health Questionnaire 9 (PHQ-9) is here: https://patient.info/doctor/patient-health-questionnaire-phq-9 The State Trait Anxiety Inventory is here: https://www.advancedassessments.co.uk/resources/Mental-Health-Test.pdf Presented by Desiree Chappell and Monty Mythen with Kristen Roman, MSN, MFA, SRNA, Ignacio Diaz, BSN, SRNA and Jena Borgonia, BSN, SRNA, student registered nurse anesthetists (SRNAs) at The University of Southern California.

Lorenzo Norris, MD, host of Psychcast, joins Blood & Cancer host David Henry, MD, to discuss steps clinicians can take to alleviate the distress associated with receiving a diagnosis of cancer. Dr. Norris is director of consult liaison psychiatry at George Washington University, Washington. Dr. Henry is clinical professor of medicine at the University of Pennsylvania, Philadelphia. Both doctors have no disclosures. A full transcript of this episode is available here: A conversation on mental health and cancer https://bit.ly/2Fgat9k   Take-home points Cancer patients have always been susceptible to developing depression and anxiety after receiving their distressing diagnoses. During the COVID-19 pandemic, the risk for depression and anxiety are even greater because patients face separation from their oncology treatment teams and for some, delays in treatment. Major depressive disorder (MDD) occurs in up to one-third of cancer patients, and any depressive disorder can be seen in about half. Another concern is how to screen for depression in the context of cancer. Dr. Norris suggests using the Patient Health Questionnaire–2 (PHQ-2) screener, or the question: “Are you sad or depressed?” Answering those questions can give patients the opportunity to open up about their emotions. Signs of depression in cancer include nonadherence to treatment, changes in mood and anxiety affecting daily functioning at home or work, and demoralization, which is defined as helplessness, isolation, and despair in the face of overwhelming stressors. Summary An emotional upset, such as disbelief, despair, or even denial, might occur immediately after receiving a cancer diagnosis. A depressive disorder, however, is a persistently depressed, sad mood with changes in functioning that affect the patient, his/her family, and even engagement with treatment. Findings of studies about the prevalence of depression in patients with cancer vary depending on the type of screening and/or diagnostic tool used. In general, the prevalence of MDD is up to 38%, and the prevalence of any depressive disorder is up to 58%. The prevalence of depression is even greater in patients with advanced cancer. In the general population, the 12-month prevalence of MDD is 6%, and the lifetime prevalence is 16%. It’s useful to think about stress along a continuum of diagnoses ranging from a normal expected stress syndrome, an adjustment disorder, MDD triggered by the event, depression secondary to a general medical condition as can occur in central nervous system and pancreatic cancer, or even a substance-induced mood disorder from either prescribed medications or perhaps a form of coping that has turned maladaptive. Cognitive-behavioral therapy (CBT) can be explained as examining the way thoughts influence emotions and behavior. When using CBT with cancer patients, a good place to start is checking in on their understanding of their diagnosis, their prognosis, and current and future treatments. The goal is to see whether they have unnecessary cognitive distortions that may be affecting their emotions and behaviors. During periods of extreme stress, CBT can help patients by emphasizing the use of adaptive thoughts, and identifying maladaptive thoughts and behaviors as opportunities for intervention. To screen for depression, it may be enough to ask: “Are you depressed?” As a screening tool, the PHQ-2 asks only two questions: “Over the last 2 weeks, how often have you been bothered by the following problems: Little interest or pleasure in doing things, or been feeling down, depressed or hopeless? The PHQ-2 score ranges from 1 to 6, and even at the lowest score, it has a sensitivity and specificity of 90.6% and 65.4%, respectively, in detecting any depressive disorder. References Krebber AMH et al. Psycho-oncology. 2014 Feb;23(2)121-30. Walker J et al. Ann Oncol. 2013 Apr 1;24(4):895-900. Trinidad AC et al. Psychiatr Ann. 2011;4(9):439-42. Daniels S. J Adv Pract Oncol. 2015 Jan-Feb;6(1):54-6. Other resources PHQ-2: https://www.hiv.uw.edu/page/mental-health-screening/phq-2 National Cancer Institute: Depression–Health Professional Version: https://www.cancer.gov/about-cancer/coping/feelings/depression-hp-pdq

David Henry, MD, host of the Blood & Cancer podcast, joins Psychcast host Lorenzo Norris, MD, to discuss steps clinicians can take to alleviate the distress associated with receiving a diagnosis of cancer. Dr. Henry is clinical professor of medicine at the University of Pennsylvania, Philadelphia. He has no disclosures. Dr. Norris is director of consult liaison psychiatry at George Washington University, Washington. He has no disclosures. Take-home points Cancer patients have always been susceptible to developing depression and anxiety after receiving their distressing diagnoses. During the COVID-19 pandemic, the risk for depression and anxiety are even greater because patients face separation from their oncology treatment teams and for some, delays in treatment. Major depressive disorder (MDD) occurs in up to one-third of cancer patients, and any depressive disorder can be seen in about half. Another concern is how to screen for depression in the context of cancer. Dr. Norris suggests using the Patient Health Questionnaire–2 (PHQ-2) screener, or the question: “Are you sad or depressed?” Answering those questions can give patients the opportunity to open up about their emotions. Signs of depression in cancer include nonadherence to treatment, changes in mood and anxiety affecting daily functioning at home or work, and demoralization, which is defined as helplessness, isolation, and despair in the face of overwhelming stressors. Summary An emotional upset, such as disbelief, despair, or even denial, might occur immediately after receiving a cancer diagnosis. A depressive disorder, however, is a persistently depressed, sad mood with changes in functioning that affect the patient, his/her family, and even engagement with treatment. Findings of studies about the prevalence of depression in patients with cancer vary depending on the type of screening and/or diagnostic tool used. In general, the prevalence of MDD is up to 38%, and the prevalence of any depressive disorder is up to 58%. The prevalence of depression is even greater in patients with advanced cancer. In the general population, the 12-month prevalence of MDD is 6%, and the lifetime prevalence is 16%. It’s useful to think about stress along a continuum of diagnoses ranging from a normal expected stress syndrome, an adjustment disorder, MDD triggered by the event, depression secondary to a general medical condition as can occur in central nervous system and pancreatic cancer, or even a substance-induced mood disorder from either prescribed medications or perhaps a form of coping that has turned maladaptive. Cognitive-behavioral therapy (CBT) can be explained as examining the way thoughts influence emotions and behavior. When using CBT with cancer patients, a good place to start is checking in on their understanding of their diagnosis, their prognosis, and current and future treatments. The goal is to see whether they have unnecessary cognitive distortions that may be affecting their emotions and behaviors. During periods of extreme stress, CBT can help patients by emphasizing the use of adaptive thoughts, and identifying maladaptive thoughts and behaviors as opportunities for intervention. To screen for depression, it may be enough to ask: “Are you depressed?” As a screening tool, the PHQ-2 asks only two questions: “Over the last 2 weeks, how often have you been bothered by the following problems: Little interest or pleasure in doing things, or been feeling down, depressed or hopeless? The PHQ-2 score ranges from 1 to 6, and even at the lowest score, it has a sensitivity and specificity of 90.6% and 65.4%, respectively, in detecting any depressive disorder. References Krebber AMH et al. Psycho-oncology. 2014 Feb;23(2)121-30. Walker J et al. Ann Oncol. 2013 Apr 1;24(4):895-900. Trinidad AC et al. Psychiatr Ann. 2011;4(9):439-42. Daniels S. J Adv Pract Oncol. 2015 Jan-Feb;6(1):54-6. Other resources PHQ-2: https://www.hiv.uw.edu/page/mental-health-screening/phq-2 National Cancer Institute: Depression–Health Professional Version: https://www.cancer.gov/about-cancer/coping/feelings/depression-hp-pdq

After working at a Veterans Affair Medical Center, hear how our guests moved into the field of emergence delirium: "upon emergence our patients were swinging and very aggressive ... there must be some way to prevent this". This fascinating piece enjoys an engaging discussion about an important topic for both patients and practitioners; how important is it for you to know a patient may suffer from post traumatic stress disorder? Do different anesthetics promote or avoid emergence delirium? Can emergence delirium cause further long term trauma? How do we deal with US military veterans specifically? Patient Health Questionnaire 9 (PHQ-9) is here: https://patient.info/doctor/patient-health-questionnaire-phq-9 The State Trait Anxiety Inventory is here: https://www.advancedassessments.co.uk/resources/Mental-Health-Test.pdf Presented by Desiree Chappell and Monty Mythen with Kristen Roman, MSN, MFA, SRNA, Ignacio Diaz, BSN, SRNA and Jena Borgonia, BSN, SRNA, student registered nurse anesthetists (SRNAs) at The University of Southern California.

¿Sientes más ansiedad de la habitual? ¿Hay momentos donde sientes una alta vulnerabilidad? ¿Tienes preocupaciones sobre lo que puede llegar a ocurrir? ¡Bienvenido al podcast 57 de Practica la Psicología Positiva! En este podcast damos respuesta a estas y muchas otras preguntas donde profundizar y curiosear sobre temas relacionados con la Psicología Positiva y, sobre todo, donde te mostraremos cómo aterrizar la psicología a la acción para construir nuevos hábitos.  Esta semana vamos a darte recursos que te ayuden a gestionar la ansiedad. Cuestionario del podcast: Patient Health Questionnaire-4 (PHQ-4) RESPUESTAS 0, nunca; 1, varios días; 2, más de la mitad de los días; 3, casi cada día. PREGUNTAS: 1) Presencia de un estado de nerviosismo y tensión. 2) Incapacidad de controlar la preocupación. Punto de corte: puntuación mayor o igual a 3.

Headline: Update on the American Psychiatric Association – Part 2   Show Notes By Jacqueline Posada, MD, 4th-year resident in the department of psychiatry & behavioral sciences at George Washington University, Washington. Lorenzo Norris, MD, interview with Saul Levin, MD, MPA, CEO and medical director of the American Psychiatric Association (APA). Dr. Levin also is clinical professor at George Washington University.   Improving access to care and impact of psychiatrists is imperative.   Finding a doctor: More physicians need to be trained. Increasing the number of physicians can be accomplished through initiatives funded by the government and by private medical centers. Innovation in training at both undergraduate and graduate levels is needed to increase the number of physicians across all specialties. Debt repayment: The APA is encouraging the federal government to diversify its loan repayment options, such as by making it possible for psychiatrists to practice in more diverse but underserved places in exchange for loan repayment. Getting to a doctor: Telepsychiatry and collaborative care are means of increasing access. Collaborative/integrative care: The psychiatrist acts as an adviser to a whole team and then offers direct patient care in more complex cases. Telepsychiatry improves access by decreasing stigma and reducing commute time to and from patient visits. Both psychiatrists and patients save time and gain convenience. Using evidence-based treatments (EBT) is important in psychiatry. One goal is to advance the use of EBT to enhance the impact of psychiatric treatment, especially by using quality measures (for example, the nine-item Patient Health Questionnaire) to validate the impact of treatment. The Centers for Medicare & Medicaid Services has given grants to medical associations such as the APA to create quality measures to quantify/validate the impact of treatments in an effort to foster more EBT in psychiatry.   Conclusion: Advocating on behalf of people with psychiatric disorders requires a broad approach. The APA lobbies for fairness, parity, and quality treatment. The group works to advance EBTs and new treatments. Recruitment of diverse individuals to psychiatry is important. “Moonshot” level research is integral to the advancement of psychiatry and the mental health of the patients. The APA strives to balance a mission of government advocacy and individual psychiatrist education. References  APA Innovation Lab  Mental health parity advocacy  Advocacy and APAPAC   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgePsych          

A discussion between Sloan Manning, MD, PsychU Primary Care Provider Corner Section Editor and Adjunct Associate Professor, Family Medicine, UNC, and his long-time patient, Lesa, about her personal journey with major depressive disorder (MDD). Lesa’s journey began with common symptomology for MDD – overwhelming thoughts, depressed mood, physical pain, and disruption in her sleep schedule – which she shared with Dr. Manning, her family primary care provider. The back and forth in this interview allows Lesa to share her experience as a patient, and have that experience placed in professional context by Dr. Manning’s treatment interpretation, starting with her initial assessment utilizing the Patient Health Questionnaire 9 (PHQ-9) and the Generalized Anxiety Disorder 7 (GAD-7) and continuing through her progression with treatment. Dr. Manning is a paid consultant for Otsuka Pharmaceutical Development & Commercialization, Inc. Disclaimer: The information provided through PsychU is intended for the educational benefit of mental health care professionals and others who support mental health care. It is not intended as, nor is it a substitute for, medical care, advice, or professional diagnosis. Health care professionals should use their independent medical judgement when reviewing PsychU's educational resources. Users seeking medical advice should consult with a health care professional. MRC2.CORP.X.02669

When tracked within its electronic medical record, key interventions like transitional care coaching and an expanded Patient Health Questionnaire not only improve the care provided to John C. Lincoln ACO's population but provide a clearer picture of the accountable care organization's performance, note Karen Furbush, business consultant, and Heather Jelonek, chief operating officer of the John C. Lincoln Network ACO. Additionally, the ACO's Physician Advisory Network, made up of its leading physicians, tracks patterns and trends within the ACO and helps the care team to adhere to best practices in evidence-based medicine. Monthly webinars with the physician advisory network and its EMR specialists provide opportunities for evaluation and training in these best practices. Karen Furbush and Heather Jelonek shared how the John C. Lincoln Network ACO has modified its reporting process, from workflow changes to customizations within its EMR to improve performance results during a July 17, 2013 webinar, "Performance Quality Measurement and Reporting for Accountable Care," a 45-minute program sponsored by The Healthcare Intelligence Network.