Podcasts about phq

Are you struggling to support young patients—and maybe even yourself—with the emotional aftermath of our “new normal”? In this compelling episode of Pediatric Meltdown, Dr. Colleen Cullinan returns to unpack the reality of pediatric depression in a world rocked by uncertainty. Discover why traditional approaches, like focusing solely on symptoms, may actually miss the bigger picture when kids are faced with unprecedented stress. Learn how changing the narrative, adopting techniques such as Acceptance and Commitment Therapy (ACT), and making small, values-driven changes can help children—and parents—find hope, function, and connection again. This episode isn't just about treating depression; it's about transforming how we relate to struggle and building resilience against the tide of ongoing adversity. Tune in for real stories, actionable tools, and a refreshing reminder: even the heaviest feelings can be given a name, a shape, and ultimately, a little less power.[00:00 - 08:40] The Impact: Symptom Overload, and Functional ImpairmentThe pandemic has significantly amplified youth mental health issues, leading to increased rates and severity of pediatric depression and anxiety.Symptom checklists like the PHQ-9 now reveal almost universal distress—so much so that a "normal" score is rare.Chronic uncertainty and prolonged stress (for both kids and adults) exacerbate feelings of hopelessness, helplessness, and irritability.The primary care challenge: shifting from symptom identification to understanding the real-life impact on activities, relationships, and overall well-being.[08:41 - 28:29] Rethinking Depression in Pediatrics: Connection, and Therapy ApproachesConnection—not just checking PHQ-9 scores—is a critical protective factor for youth mental health and should be the heart of clinical encounters.Traditional Cognitive Behavioral Therapy (CBT) and newer Acceptance and Commitment Therapy (ACT) are compared — with ACT focusing on accepting thoughts and changing relationships with them, not just “fixing” or disputing them.Dr. Cullinan explains how ACT techniques, including physicalizing and naming despair, help kids distance from and better manage their feelings.The “beach ball” metaphor illustrates how fighting negative thoughts can cause you to miss life's joys—and how letting them coexist with living can restore function and hope.[28:30 -58:59] Strategies: Playful Experiments, Values-Based Goals, Motivational ToolsPractical examples include using humor, metaphor, and even quick physical challenges (like the “lemon” exercise) to help kids gain distance from distressing thoughts.Naming depressive feelings or thoughts (e.g., “pathetic,” “Bob”) can help externalize and reduce their influence, making them easier to talk about and manage.Motivational Interviewing is highlighted as a powerful tool—but only if it genuinely centers each child's unique values and interests, not the provider's agenda.Avoidance, not just the presence of sadness or fear, is flagged as the true engine of suffering; the focus shifts to acceptance and gentle behavioral activation.[59:00-1:06:47] Building Resilience: Safety, Nurture, New Frames, and Practical PearlsChildren's beliefs and “frames” about themselves and the world are shaped by repeated messages—caregivers can help reframe these with new, nurturing narratives.Safe, stable, nurturing relationships offer the strongest protection and resilience against depression and trauma, as explored through frameworks like toxic stress and child transformation health.Providers can make meaningful impact in just minutes with new language, metaphors, and reframing exercises—even in a busy primary care setting.[1:06:48 -...

Wie häufig kommen Depressionen in der Hausarztpraxis vor? Welche Symptome sollten die Ärztin und den Arzt aufhorchen lassen? Und wie sieht die leitliniengerechte Therapie bei einer depressiven Episode aus? In dieser Folge von O-Ton Allgemeinmedizin sprechen wir mit Dr. Michelle Hildebrandt darüber, wie sich die Versorgungslage depressiver Menschen verbessern lässt. Ein besonderer Fokus liegt auf Diagnostik und Therapieoptionen bei unipolarer Depression – von Antidepressiva über Psychotherapie bis hin zur Sporttherapie – sowie auf gendermedizinischen Aspekten und der Suizidanamnese. Gast dieser Folge: Dr. Michelle Hildebrandt, Fachärztin für Psychiatrie und Psychotherapie sowie Sachbuchautorin, Lübeck Hosts dieser Folge: Maximilian Rossol, Tobias Stolzenberg, Medizinredakteure bei Medical Tribune, Wiesbaden Zur Folgen-Übersicht: https://bit.ly/4hoYfbK Weiterführende Links: • Stiftung Deutsche Depressionshilfe und Suizidprävention: https://www.deutsche-depressionshilfe.de/start • PDF-Download des Beck-Inventions-Inventar, BDI-II: https://www.schmerztherapiezentrum-hagen.de/downloads/BDI_Fragebogen.pdf • Download des PHQ-9, Screening-Fragebogen zur Diagnostik von Depressivität für den Einsatz im somatisch-medizinischen Bereich: https://www.uke.de/dateien/institute/institut-und-poliklinik-f%C3%BCr-psychosomatische-medizin-und-psychotherapie/downloads/phq-9.pdf • S3-Leitlinie, Nationale VersorgungsLeitlinie Unipolare Depression, AWMF online: https://register.awmf.org/de/leitlinien/detail/nvl-005 • Deutsche Gesellschaft für Psychologie (DGPs): https://www.dgps.de/ • Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde e.V. (DGPPN): https://www.dgppn.de/ Dr. Hildebrandts aktuelles Buch zur Hochfunktionalen Depression: Hochfunktionale Depression. Das Übersehene Leiden Ein Aufklärungsbuch. Fallbeispiele und Behandlungsansätze aus kognitiver Verhaltenstherapie, Resilienzforschung und Entspannungsverfahren S. Hirzel Verlag GmbH, Erscheinungsdatum 15.10.2024 200 Seiten, Softcover ISBN 978-3-7776-3383-1 22,00 EUR (E-Book: 19,90 EUR) Zur Verlagshomepage S. Hirzel Verlag: https://www.hirzel.de/hochfunktionale-depression.-das-uebersehene-leiden/9783777633831 Weitere Folgen zum Thema psychische Erkrankungen in O-Ton Allgemeinmedizin: • Folge 26 (02.05.24): Psychosomatik • Folge 38 (31.10.24): Verhaltenssüchte • Folge 40 (28.11.24): Psychische Erkrankungen in der Hausarztpraxis • Folge 42 (13.02.25): Schlafprobleme Weitere Folgen zum Thema psychische Erkrankungen in O-Ton Pädiatrie: • Folge 12 (11.03.25): Jugend und Sucht Andere Podcasts zum Thema „Männerdepression“ und „Hochfunktionale Depression: Depressionen bei Männern – eher gereizt als niedergeschlagen; aus dem Podcast „Wie wir ticken“ in der ARD-Audiothek: https://www.ardaudiothek.de/episode/wie-wir-ticken-euer-psychologie-podcast/depressionen-bei-maennern-eher-gereizt-als-niedergeschlagen/ard/14122551/ Hochfunktionale Depression – wenn keiner merkt, was los ist; aus dem Podcast „Die Lösung“ in der ARD-Audiothek: https://www.ardaudiothek.de/episode/die-loesung-der-psychologie-podcast/hochfunktionale-depression-wenn-keiner-merkt-was-los-ist/br/14102621/

Send us a message with this link, we would love to hear from you. Standard message rates may apply.Depression requires a comprehensive treatment approach addressing biological, psychological, and social dimensions for true healing. We explore the three essential components of effective depression management: medication, therapy, and behavioral activation.• Depression categorized as mild, moderate, or severe, with treatment options varying accordingly• PHQ-9 questionnaire serves as both diagnostic tool and progress tracker• SSRIs (like Lexapro, Prozac, and Zoloft) serve as first-line medications with fewer side effects• Antidepressants typically require six weeks at therapeutic dose to determine effectiveness• Psychotherapy, especially cognitive behavioral therapy, proven equally effective as medication• Combined medication and therapy approach provides superior outcomes to either alone• Psychology Today website offers accessible therapist-finding tool• Exercise (30-60 minutes, 3x weekly) prescribed as essential treatment component• Behavioral activation through resuming enjoyable activities crucial for recovery• Recovery is possible with comprehensive treatment even when motivation is lowVisit psychologytoday.com to find therapists in your area based on specialty, insurance coverage, session format, and more.Support the showProduction and Content: Edward Delesky, MD & Nicole Aruffo, RNArtwork: Olivia Pawlowski

Do you suspect that you have depression or related mental disorders? Take Mission Connection's (866-833-1822) PHQ-9 test, which you can complete in just two minutes, to determine whether you should seek professional help. Take the test at https://missionconnectionhealthcare.com/blog/quiz/depression-test/ Mission Connection City: San Juan Capistrano Address: 30310 Rancho Viejo Rd. Website: https://missionconnectionhealthcare.com/

Psychische Erkrankungen in der Hausarztpraxis – Herausforderungen und Chancen Psychische Störungen gehören in der Hausarztpraxis zu den häufigsten Krankheitsbildern. Doch oft startet die Behandlung zu spät, oder die Erkrankung bleibt unerkannt. In dieser Folge von „O-Ton Allgemeinmedizin“ werfen wir einen genauen Blick darauf, wie Hausärztinnen und Hausärzte psychische Erkrankungen wie Depressionen, Angststörungen oder somatoforme Schmerzerkrankungen erkennen und behandeln können. Unser Gast Prof. Dr. Jochen Gensichen, Leiter des Instituts für Allgemeinmedizin am LMU Klinikum München, erläutert die Bedeutung der Früherkennung und der zielgerichteten Gesprächsführung. Er beschreibt, welche Unterstützung es für Hausärztinnen und Hausärzte gibt und legt dar, wie sich die Stigmatisierung psychischer Erkrankungen abbauen lässt. Ausführlich geht er dabei auf psychologische Kurzinterventionen für die Hausarztpraxis ein. Themen dieser Folge: • Warum psychische Erkrankungen oft unerkannt bleiben • Wie Hausärztinnen und Hausärzte Früherkennung betreiben können • Bedeutung einer empathischen Patientenkommunikation • Grenzen und Möglichkeiten der hausärztlichen Versorgung • Interdisziplinäre Zusammenarbeit und Überweisungen zum Spezialisten • Wege zur Entstigmatisierung psychischer Erkrankungen Host dieser Folge: Tobias Stolzenberg, Redakteur bei der Medical Tribune, Wiesbaden Zum Folgen-Überblick: https://bit.ly/4hoYfbK Praxishandbuch zum Thema: Psychologische Kurzinterventionen – Für die Hausarztpraxis und die psychosomatische Grundversorgung Jochen Gensichen, Mathias Berger, Martin Härter (Herausgeber) Softcover, 144 Seiten, erschienen Sept. 2023 Urban & Fischer (Elsevier) ISBN: 978-3-437-15270-2 53 Euro Weiterführende Links und Ressourcen: Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM): https://www.degam.de/ Stiftung Allgemeinmedizin: https://www.stiftung-allgemeinmedizin.de/ Instrumente für die Hausarztpraxis, Zusammenstellung der LMU München: https://www.lmu-klinikum.de/institut-allgemeinmedizin/forschung/instrumente/6652ef4bb52818af PHQ-9, Screening-Fragebogen zur Diagnostik von Depressivität für den Einsatz im somatisch-medizinischen Bereich: https://www.uke.de/dateien/institute/institut-und-poliklinik-f%C3%BCr-psychosomatische-medizin-und-psychotherapie/downloads/phq-9.pdf OASIS-D, Kurzfragebogen, Diagnosetool für Angststörungen: https://www.lmu-klinikum.de/institut-allgemeinmedizin/forschung/instrumente/__scrivito/6652ef4bb52818af/#oasis Deutsche Gesellschaft für Psychologie (DGPs): https://www.dgps.de/ Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde e.V. (DGPPN) https://www.dgppn.de/

Enjoy the episode? Send us a text!Can a marriage survive the weight of depression? Join us in this eye-opening episode of Relationship Radio as we tackle this pressing question and guide you through the labyrinth of depression within a marriage in crisis. We break down major depressive disorder, its symptoms, and the PHQ-9 screening tool to help you understand the profound impact depression can have on both individuals and their relationships. We explore how biochemical imbalances and external stressors like infidelity can exacerbate the situation, reinforcing the importance of seeking professional help.Moreover, we offer a lifeline of hope and practical solutions to reclaim your mental health and strengthen your marriage. We discuss a range of treatment options including medication, cognitive behavioral therapy, and even innovative methods like magnetic therapy. We share promising insights on the effectiveness of these treatments, especially magnetic therapy, urging listeners to take proactive measures. This episode is packed with essential information and heartfelt advice, designed to support both individual well-being and the health of your relationship. Don't miss this opportunity to learn how to navigate and overcome depression in your marriage.

In this conversation, Liz Rohr and Shelby Pope discuss the importance of taking a comprehensive history of substance use, and how to assess and treat stimulant use disorder. They cover the challenges healthcare providers face in asking the right questions, and emphasize the need for open conversations and non-judgmental approaches.They cover screening for addiction, how to elicit a substance use history, including types and routes of substance use. Shelby covers the mechanism of action of cocaine and methamphetamine in the brain, the withdrawal symptoms associated with stimulant use disorder, and the next steps for primary care providers in managing patients with stimulant use disorder. They also explore the use of psychosocial interventions and off-label pharmacologic treatments for stimulant use disorder.TakeawaysOpen and non-judgmental conversations are essential when discussing substance use with patients.Screening practices, such as using screeners like PHQ-2, SBIRT, and DAST, can help identify substance misuse or struggles.Taking a comprehensive history of substance use, including the type, amount, frequency, and motivation, is crucial for providing appropriate care.Healthcare providers should be aware of the different routes of administration and the potential risks associated with each.Stimulant use disorder, particularly cocaine and methamphetamine use, can have significant adverse effects and poor outcomes. Cocaine and methamphetamine are both monoamine neurotransmitter reuptake inhibitors, increasing serotonin, norepinephrine, and dopamine levels in the brain.There is a withdrawal syndrome associated with stimulant use disorder, characterized by depression, fatigue, and sleep disturbances.In managing patients with stimulant use disorder, primary care providers should consider triage based on severity and acuity, and refer patients to appropriate resources such as rehab or the ER.Psychosocial interventions, such as cognitive behavioral therapy and contingency management, are the mainstay of treatment for stimulant use disorder.Off-label pharmacologic treatments for stimulant use disorder include mirtazapine, bupropion, injectable naltrexone, topiramate, and psychostimulants.It is important for healthcare providers to be aware of state regulations and their own comfort level in prescribing off-label medications for stimulant use disorder.For a full transcript and conversation chapters, visit the blog: https://www.realworldnp.com/blog/treating-substance-use-disorder ______________________________© 2024 Real World NP. For educational and informational purposes only, see realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Vida Plena's 2023 Impact Report: Measuring Progress and Looking Ahead, published by Vida Plena on July 23, 2024 on The Effective Altruism Forum. We from Vida Plena are proud to present our first Annual Impact Report. 2023 was our first full year. It was a year of learning. We had just finished a successful pilot and started the year with the mission of building a solid foundation and proving that our therapy model works at scale. This first annual impact report is our attempt to capture through charts and graphs bits of crucial evidence about who we've helped in 2023 and where we can continue to improve. Background Context Vida Plena (meaning 'a flourishing life' in Spanish) is a nonprofit organization based in Quito, Ecuador which launched in 2022 (see our launch post here). Our mission is to build strong mental health in low-income and refugee communities, who otherwise would have no access to care. We provide evidence-based depression treatment using group interpersonal therapy, which is highly cost-effective and scalable. Main Findings Our main findings during the process of creating this report were: In 2023, we screened 882 people for depression. 434 (49%) of these became participants, taking at least 1 group session. Program participants had an average reduction of 6.6 in the PHQ-9 questionnaire. 68% of participants with moderate to severe depression clinically improved (5 points drop in PHQ-9). Five points are considered to be a clinically significant improvement. We also saw reductions in secondary indicators of self-harm thoughts and suicidal ideation, anxiety, psychosocial functioning, and employment. Participants who fill out our end-line survey also report high satisfaction with the program and increased feelings of hope and purpose. 90% of participants came from vulnerable groups, the most common of which were people experiencing food insecurity (56%), female heads of households (34%), and migrants and refugees (22%). Participant recovery seems to be related mostly to the baseline level of depression and not so much to the number of sessions taken or other variables like the modality of the sessions (virtual or in person). Challenges While we are excited with these results, there are many challenges and areas we still feel we need to improve. In particular: Even though 5 points is considered to be a clinically significant change on the PHQ-9 scale, the 6.6-point drop is still below our more ambitious target. In 2024, we aim to improve this margin to nine points across participants entering with moderate to severe depression. Relatedly, we aim to improve our participant retention rate. Our initial findings suggest that participants may drop out when they start feeling better. We believe there is room for them to continue improving and learning important skills to enhance their resilience and strengthen their support network if they attend more therapy sessions. Limitations We are also aware that this first report has limitations. First, we rely basically on pre-post participant comparisons, with no randomized control group. We try to partially compensate for this fact by considering spontaneous remission data from the scientific literature. However, our priority in the coming years is to implement control groups where people who are not involved in Vida Plena g-IPT sessions take PHQ-9 assessments over eight weeks to determine our population's spontaneous remission rates. Secondly, some of the data we collect is likely subject to multiple biases. For example, the program satisfaction data we have, as well as many secondary indicators, come from people who take the end-line survey by the end of their 8th group session. People who get so far into the program without dropping out are likely the ones who saw the most value in it, and this can skew our conclus...

Summary. Who We Are: Kaya Guides runs a self-help course on WhatsApp to reduce depression at scale in low and middle-income countries. We help young adults with moderate to severe depression. Kaya currently operates in India. We are the world's first nonprofit implementer of Step-by-Step, the World Health Organization's digital guided self-help program, which was proven effective in two RCTs. Pilot: We ran a pilot with 103 participants in India to assess the feasibility of implementing our program on WhatsApp with our target demographic and to generate early indicators of its effectiveness. Results: 72% of program completers experienced depression reduction of 50% or greater. 36% were depression-free. 92% moved down at least a classification in severity (i.e. they shifted from severe to moderately severe, moderately severe to moderate, etc). The average reduction in score was 10 points on the 27-point PHQ-9 depression questionnaire. Context: To offer a few [...] ---Outline:(04:44) Part 1. About the Kaya Guides Program(04:49) What is Kaya Guides and what do we do?(05:13) How the program works(05:35) Evidence base(06:11) Why guided self-help is effective(06:50) Why this work matters(07:52) Program design(08:46) Target participant profile(09:14) Impact measurement(10:00) Part 2. Pilot Impact and Cost-Effectiveness(10:18) Impacts on depression(11:01) Comparison(12:10) Effect Size Estimate(14:35) Takeaway(15:02) Cost-Effectiveness(15:29) Pilot Cost-Effectiveness(17:15) 2025 Projected Cost-Effectiveness(19:15) Program Impacts According to Participants(22:50) Part 3. Recruitment(22:55) Quick Stats(24:20) Participant Profile(25:38) Part 4. Retention(27:45) Part 5. Participant Feedback(31:19) What's Next(32:05) Support Us--- First published: June 16th, 2024 Source: https://forum.effectivealtruism.org/posts/6NaRJpSn2zfRSnGYN/kaya-guides-pilot-results --- Narrated by TYPE III AUDIO.

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Kaya Guides Pilot Results, published by RachelAbbott on June 16, 2024 on The Effective Altruism Forum. Summary Who We Are: Kaya Guides runs a self-help course on WhatsApp to reduce depression at scale in low and middle-income countries. We help young adults with moderate to severe depression. Kaya currently operates in India. We are the world's first nonprofit implementer of Step-by-Step, the World Health Organization's digital guided self-help program, which was proven effective in two RCTs. Pilot: We ran a pilot with 103 participants in India to assess the feasibility of implementing our program on WhatsApp with our target demographic and to generate early indicators of its effectiveness. Results: 72% of program completers experienced depression reduction of 50% or greater. 36% were depression-free. 92% moved down at least a classification in severity (i.e. they shifted from severe to moderately severe, moderately severe to moderate, etc). The average reduction in score was 10 points on the 27-point PHQ-9 depression questionnaire. Context: To offer a few points of comparison, two studies of therapy-driven programs found that 46% and 57.5% of participants experienced reductions of 50% or more, compared to our result of 72%. For the original version of Step-by-Step, it was 37.1%. There was an average PHQ-9 reduction of 6 points compared to our result of 10 points. Effect Size: Our effect size is estimated at 0.54, compared to an effect size of 0.48 for the original version of Step-by-Step. This is likely to be an upper bound. Cost-Effectiveness: We estimate that the pilot was 7x as cost-effective as direct cash transfers at increasing subjective well being. This accounts for the initial effect, not duration of effects. The cost per participant was $96.27. We project that next year we will be 20x as cost-effective as direct cash transfers. These numbers don't reflect our full impact, as we may be saving lives. Four participants said overtly that the program reduced their suicidal thinking. Impacts: Participants reported that the program had profound impacts on their lives, ranging from improved well-being to regaining control over their lives and advancing in their education and careers. Recruitment: We were highly successful at recruiting our target population. 97% of people who completed the baseline depression questionnaire scored as having depression. 82% scored moderate to severe. Many of our participants came from lower-income backgrounds even though we did not explicitly seek out this group. Participants held professions such as domestic worker, construction and factory worker and small shopkeeper. 17% overtly brought up financial issues during their guide calls. Retention: 27% of participants completed all the program content, compared to 32% in the WHO's most recent RCT. In the context of a digitally-delivered mental health intervention, which are notorious for having extremely low engagement, this is a strong result. Guide call retention was higher: 36% of participants attended at least four guide calls. Participant Feedback: 96% of program completers said they were likely or very likely to recommend the program. Participant feedback on guide calls was overwhelmingly positive and their commentary gave the sense that guide calls directly drive participant engagement. Negative feedback focused on wanting more interaction with guides. Feedback on the videos was mixed. For the chatbot, it was neutral. Feedback on the exercises was generally positive for the exercises, although there were signs of lack of engagement with some exercises. The stress reduction exercises were heavily favored. Support Kaya Guides: To support us, donate here or contact Rachel Abbott at rachel@kayaguides.com. Per our most recent assessment, it costs us $96 to provide mental healthcare t...

A 28-year-old woman presents with new onset worsening fatigue, present for approximately the last month. She is 28 weeks pregnant with her second child, has a 1.5-year-old healthy child at home, says she remembers being tired towards the end of her pregnancy with her first child, but states, “This is worse than with my last pregnancy”. She denies vaginal bleeding or discharge, abdominal pain, or other concerning issues, is sleeping about 7 hours per night, and has adequate access to nutritious food. She is not taking a prenatal vitamin, reporting, “I kept throwing up every time I took one.” During early pregnancy. PHQ-9 screening tool results are without concern.Labs results are as follows.Hemoglobin 9.2g per dl (NL=12-14)Hct=27% (NL=36-42%)Total RBC= 2.9 million (3.9 to 5.2 million cells per microliter (million/µL)MCV 75 FL (NL=80-98)MCH 22 PG (NL=27-33)RDW 18% (NL=11.5-15%)These results are most consistent with:A. Pregnancy related hemodilution.B. Folic acid deficiency anemiaC. Iron deficiency anemia.D. Beta thalassemia minor.Visit fhea.com to learn more!

Join Catherine on this episode of Social Workers, Rise! as she delves into the crucial topic of assessing and addressing depression in clients. With staggering statistics revealing the prevalence of depression worldwide, Catherine emphasizes the importance of initiating conversations and reducing stigma surrounding mental health. Tune in for an exclusive excerpt from her course, 'The Clinical Essentials for the Future Therapist,' designed to empower new practitioners and enhance therapeutic skills. Learn about practical assessment tools like the PHQ-9 and gain valuable insights to navigate the complexities of depression in clinical practice. ____________________________________ ⁠Tap Here to Subscribe⁠ to the Social Workers, Rise! Email Resource List ⁠Tap Here⁠ to shop career courses for Social Workers. ____________________________________ Thank you to our SPONSORS ⁠RISE Directory⁠ - A national directory of Clinical Supervisors who are looking to help the next generation of Clinical Social Workers GROW. ⁠Therapist Development Center (TDC) Homepage⁠ ⁠TDC Continuing Education Courses⁠ ⁠On The Edge of Life: An Introduction to Treating Suicidality ⁠ Use the code SWRISE10 at checkout to receive 10% off --- Send in a voice message: https://podcasters.spotify.com/pod/show/socialwork/message Support this podcast: https://podcasters.spotify.com/pod/show/socialwork/support

This week's replay is Dr. Fareeha Malik, DDS, mom of 2 with a history of severe postpartum depression. PPD ended up informing her relationships and and even her reproduction. Of course, we discuss how she she found healing. Bringing home a baby doesn't always mean mom's eternal happiness. Not all mothers feel “the way they should” after the baby is born, and may feel lost if they don't know where to turn for resources. This endangers not only mom but also a newborn.In a time when 14000 children have been unalived in a completely manmade g-cide, this episode still has its place as one of the struggles mothers face. And for those of our momsisters delivering via C-section without anesthesia, delivering prematurely due to stress, shock, and manmade famine, PPD is a real threat with deep seated claws. May Allah SWT first and foremost secure the survival of our momsisters and their newborns born in an ongoing g-cide, and protect them from every evil of the heart and mind, and destroy the enemies who threaten their physical states. Ameen. We were so into the conversation that we didn't get to review the valuable resources we have for our community. check out the shownotes on our website or DM us.Links:1. Edinburgh Postnatal Depression Scale: http://perinatology.com/calculators/Edinburgh%20Depression%20Scale.html2. PHQ-9 Screening Tool: https://www.integration.samhsa.gov/images/res/PHQ%20-%20Questions.pdf3. American College of Obstetrics & Gynecology patient handout on PPD: https://www.acog.org/Patients/FAQs/Postpartum-Depression?IsMobileSet=false4. Nisa Helpline: https://nisahelpline.com/who-we-are/ 1-888-315-NISA (6472)  available 12 hours during the day, or email info@nisahelpline.com anytime5. National Suicide Prevention Hotline: 1-800-273-8255 available 24/7 for helpSupport the show1. Web: www.mommyingwhilemuslim.com2. Email: salam@mommyingwhilemuslim.com3. FB: Mommying While Muslim page and Mommyingwhilemuslim group4. IG: @mommyingwhilemuslimpodcast5. YouTube: https://www.youtube.com/channel/UCrrdKxpBdBO4ZLwB1kTmz1w

In this episode of Derms and Conditions, host James Q Del Rosso, DO, sits down with Jennifer Hsiao, MD, associate professor of clinical dermatology at Keck Medicine of University of Southern California, to discuss the multifaceted world of hidradenitis suppurativa (HS). From addressing diagnostic obstacles to understanding comorbidities, this episode guides clinicians through the many complexities of HS management. They begin by exploring the diagnostic hurdles associated with HS, with Dr Hsiao sharing insights to help clinicians navigate through potential misdiagnoses. She emphasizes the importance of recognizing subtle indicators of the disease and thinking outside the box when it comes to the location of lesions, as they may present in atypical areas. She also highlights the significance of recurrent history, which can serve as a diagnostic hallmark. Next, the pair discusses comorbidities associated with HS, with Dr Hsiao detailing the importance of inquiring about patients' primary care arrangements. She notes that while dermatologists may not directly manage these comorbidities, they can play a vital role in identifying and initiating the necessary steps toward management. The discussion then moves to the significant psychological impact of HS, emphasizing the necessity of open dialogue with patients about the psychological toll of HS and the benefits of seeking mental health support. Screening tools like the PHQ-2 can aid in identifying patients at risk and initiating necessary interventions. They next address the limitations of current clinical guidelines for HS and the need for a paradigm shift towards intervening earlier in the disease process to prevent irreversible tissue damage. The discussion concludes with the presentation of a clinical scenario describing a patient transitioning from oral antibiotics to a biologic, with Dr Hsiao outlining her suggested approach for such a patient.

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

This episode comes with a trigger warning for mental health and depression. Below you will find a list provided by Dr Hamilton for contact and support. 1.Are you experiencing a mental health crisis? If you need help urgently, but it's not a life-threatening emergency contact the First Response Service (FRS) by dialing 111 and choosing option 2. 2. Self help Every Mind Matters - NHS (www.nhs.uk) Living Life to the Full | Self Help Resources | Online CBT Courses (llttf.com) Mental health | Reading Well booklists | Books | Reading Well (reading-well.org.uk) 3. Mindfulness Mindfulness - NHS (www.nhs.uk) 4. Better sleep video players.brightcove.net/4934638104001/default_default/index.html?videoId=6090024723001 5. Be active Be active for your mental health - Every Mind Matters - NHS (www.nhs.uk) 6. Self Help CBT techniques Online self-help CBT techniques - Every Mind Matters - NHS (www.nhs.uk) 7. MIND  Depression - Mind 8. Samaritans Whatever you're going through, a Samaritan will face it with you. We're here 24 hours a day, 365 days a year. Call 116 123 for free 9. Campaign against living miserably – CALM Call 0800 58 58 58 Homepage | Campaign Against Living Miserably (CALM) (thecalmzone.net) 10. Papyrus Papyrus UK Suicide Prevention | Prevention of Young Suicide (papyrus-uk.org) 11. SHOUT – Crisis helpline Text “SHOUT” to 85258 Get help - free, 24/7, confidential mental health text support service | Shout 85258 (giveusashout.org) 12. PHQ-9 Depression Test Questionnaire | Patient

Tag along as psychiatrists Dr. Julie Anderson and Dr. Sean Stanley unravel the complexities of Major Depressive Disorder (MDD). In this first of two podcasts on mood disorders, they explain MDD's neurological basis, diagnosis, suicide risk assessment, and treatments ranging from medications to psychotherapy to lifestyle changes. A thoughtful discussion of MDD's multifaceted impacts ideal for medical learners, physicians, and interested minds alike. References: Patient Health Questionnaire (PHQ-9 & PHQ-2) Collaborative Care Model Columbia-Suicide Severity Rating Scale (C-SSRS) My Resilience in Adolescence (MYRIAD) Project   Barbui, C., Cipriani, A., & Geddes, J. R. (2008). Antidepressants and suicide symptoms: compelling new insights from the FDA's analysis of individual patient level data. BMJ Ment Health, 11(2), 34-35. Fournier, J. C., DeRubeis, R. J., Hollon, S. D., Dimidjian, S., Amsterdam, J. D., Shelton, R. C., & Fawcett, J. (2010). Antidepressant drug effects and depression severity: a patient-level meta-analysis. Jama, 303(1), 47-53.

The prevalence of mental health issues is greater in patients with cardiovascular disease than the general population--but do you know what to look for? Guest Valerie Hoover, PhD, discusses the connection of both positive and negative psychological factors on cardiac outcomes, the importance of symptom recognition, and how regular screening for depression using a validated tool can make a significant difference for patients.Assessment of Depression and Depressive Systems. Depression and Coronary Heart Disease (AHA 2008): https://www.ahajournals.org/doi/full/10.1161/circulationaha.108.190769 Screening and Management of Depression in Patients with CVD (ACC 2019): https://www.jacc.org/doi/abs/10.1016/j.jacc.2019.01.041 Depression Screening and Treatment Guidlines in Cardiac Patients (2022). https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.122.009338 PHQ-2: https://www.hiv.uw.edu/page/mental-health-screening/phq-2 Comparison of PHQ-2 and PHQ-9 to Predict Death or Rehospitalization in Heart Failure (Circulation, 2015): https://www.ahajournals.org/doi/full/10.1161/circheartfailure.114.001488 PHQ-2 and PHQ-9 (Heart Foundation): https://www.heartfoundation.org.au/getmedia/52e4d9ab-dbb1-47a6-bb41-94b986176910/Depression-screening-support-tool.PDF Cardiac Distress Inventory (Australian Centre for Heart Health): https://www.australianhearthealth.org.au/resources/p/cardiac-distress-inventoryPsychosocial Factors and CVD (JACC 2020): https://www.ahajournals.org/doi/10.1161/JAHA.120.017112 See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Medicalisation is the how human experience becomes something that needs medical attention.There are pros and cons of this including the ‘need' for medicine vs something that is being sold to us something that is unnecessary.I look at some examples in this episode and why it is something that needs consideration.Links:Ivan Illich: https://www.theguardian.com/news/2002/dec/09/guardianobituaries.highereducationSadness vs depression?: https://www.sciencedirect.com/science/article/abs/pii/S0277953617302551#:~:text=Medicalization%20describes%20a%20process%20by,normal%20behavior%20into%20medical%20conditions.A discussion on medicalisation: https://news.harvard.edu/gazette/story/2009/04/scholars-discuss-medicalization-of-formerly-normal-characteristicsThe story behind PHQ-9 and assessing depression: https://www.medicalrepublic.com.au/strange-history-of-a-depression-screening-tool/86457Lay referral: https://bjgp.org/content/49/445/617THE HEALTH FIX (paperback version out Jan 24)!: https://www.amazon.co.uk/Health-Fix-Transform-Your-Weeks/dp/1914239296https://www.amazon.co.uk/Health-Fix-Transform-Your-Weeks/dp/1914239296 Hosted on Acast. See acast.com/privacy for more information.

Dr. Josef Witt-Doerring's journey, spanning from his time at the FDA to his transition into the pharmaceutical industry and eventual establishment of a private practice, is marked by its uniqueness. His commitment to vocalizing his concerns and upholding ethical standards challenges the traditional practices often associated with his field.Dr. Josef Witt-Doerring is a psychiatrist who specializes in tapering patients off psychiatric medications. Over the last four years he has helped hundreds of patients successfully stop their psychiatric medications. He is a trained expert in psychiatric medicine and in the identification and treatment of adverse drug reactions. Dr. Witt-Doerring has also had the privilege of helping several patients with litigation related to psychiatric drug injuries. 
Witt-Doerring PsychiatryDr. Josef: Social Media and Professional LinksNote: This podcast episode is designed solely for informational and educational purposes, without endorsing or promoting any specific medical treatments. We strongly advise consulting with a qualified healthcare professional before making any medical decisions or taking any actions.*If you are in crisis or believe you have an emergency, please contact your doctor or dial 911. If you are contemplating suicide, call 1-800-273-TALK to speak with a trained and skilled counselor.RADICALLY GENUINE PODCASTDr. Roger McFillin / Radically Genuine WebsiteYouTube @RadicallyGenuineDr. Roger McFillin (@DrMcFillin) / X (Twitter)Substack | Radically Genuine | Dr. Roger McFillinInstagram @radicallygenuineContact Radically Genuine—-----------FREE DOWNLOAD! DISTRESS TOLERANCE SKILLS—----------ADDITIONAL RESOURCES2:00 - Dr. Josef Witt-Doerring Open Letter to Psychiatric and Family Medicine Colleagues23:30 - Patient Health Questionnaire (PHQ-9 & PHQ-2)24:00 - Enduring pain: how a 1996 opioid policy change had long-lasting effects24:30 - Liability and Patient Suicide - PMC25:00 - Reframing the Key Questions Regarding Screening for Suicide Risk | Depressive Disorders | JAMA28:00 - The Treatment for Adolescents With Depression Study (TADS): Long-term Effectiveness and Safety Outcomes30:30 - Accutane: iPLEDGE41:00 - PDUFA VII: Fiscal Years 2023 – 2027 | FDA49:00 - Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy51:00 - Dr. Josef YouTube: Antidepressants Nearly Ruined my Marriage1:02:00 - David Healy: Post-SSRI Sexual Dysfunction | RxISK1:08:00 - Antidepressants and Mass Shootings/Murder Suicide: An interview with Dr. David Healy1:13:00 - Your Consent is Not Required - Rob Wipond1:46:00 - The Coddling of the American Mind: How Good Intentions and Bad Ideas Are Setting Up a Generation for Failure: Lukianoff, Greg, Haidt, Jonathan

In the latest episode of the #BuzzPodcast, Mark Hyder is joined by QRM's Director of Reimbursement, Megan Ussery, and Sr. VP of Integrity and Quality Improvement, Stacey Hallissey, to discuss CMS's move from the PHQ-9 to the PHQ-2 to 9 assessment model.

Dr. Julia Rowland shares the newest evidence-based recommendations from SIO and ASCO on integrative therapies for managing anxiety and depression symptoms in adults with cancer. Listen in to hear recommended options, such as acupuncture, aromatherapy, hypnosis, mindfulness, music therapy, relaxation, reflexology, Tai Chi and/or Qigong, and yoga. Dr. Rowland also discusses therapies the panel investigated but found insufficient evidence to support a recommendation for use in treating anxiety and depression. We also review how this guideline complements the recent ASCO guideline on conventional therapies for managing anxiety and depression, and the impact for patients and clinicians. Read the full guideline, "Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults with Cancer: SIO-ASCO Guideline" at www.asco.org/survivorship-guidelines TRANSCRIPT This guideline, clinical tools, and resources are available at www.asco.org/survivorship-guidelines. Read the full text of the update and review authors' disclosures of potential conflicts of interest disclosures in the Journal of Clinical Oncology, https://ascopubs.org/doi/10.1200/JCO.23.00857    Brittany Harvey: Hello and welcome to the ASCO Guidelines Podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges, and advances in oncology. You can find all the shows, including this one, at asco.org/podcasts.  My name is Brittany Harvey and today I'm interviewing Dr. Julia Rowland from the Smith Center for Healing in the Arts, Co-chair on “Integrative Oncology Care of Anxiety and Depressive Symptoms in Adult Patients with Cancer: Society for Integrative Oncology – American Society of Clinical Oncology Guideline.”  Thank you for being here, Dr. Rowland.   Dr. Julia Rowland: Lovely to be here, Brittany. Thanks for this opportunity.  Brittany Harvey: We're glad to have you on.  Then before we discuss this guideline, I'd just like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including the guest on this episode, are available in line with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes.  So then I'd like to jump into the content of this guideline. So Dr. Rowland, what is the purpose of this joint SIO and ASCO guideline?  Dr. Julia Rowland: The purpose of the joint guideline, Brittany, published in the Journal of Clinical Oncology is to provide evidence-based recommendations to healthcare providers on integrative approaches to managing anxiety and depression symptoms in their adult cancer patients. By integrative approaches, we mean such interventions as yoga, relaxation, hypnosis, mindfulness, acupuncture, music therapy in treating anxiety and depression. Many of these therapies are already being used by people with cancer both during and after their treatment, with rates increasing over time. While use of integrative interventions can serve to improve quality of life, reduce stress, and provide individuals with a sense of control over their health, and they're often reported by patients as doing just that, it's important to note that for the purpose of this guideline, we examine specifically the ability of these interventions to significantly reduce symptoms of anxiety and depression. Brittany Harvey: Great. And then, as you just mentioned, this guideline covers both anxiety and depression. So then I'd like to review the recommendations made by the expert panel and we'll go in order of those. So starting with those recommendations for anxiety, what integrative therapies are recommended for managing symptoms of anxiety experienced after diagnosis or during active treatment?  Dr. Julia Rowland: The strongest recommendations in the guideline are for the use of mindfulness-based interventions, which include mindfulness-based stress reduction, meditation, and mindful movement. These interventions were recommended across the board to treat both anxiety and depression symptoms in patients in active treatment, and those post-treatment due to the strong evidence to show their benefits to patients. Yoga was also recommended for patients with breast cancer to treat both anxiety and depression symptoms, although the strength of the evidence was moderate. Data was less compelling for its use during or after treatment in other cancers, likely due to the lack of small numbers of non-breast cancer survivors included in study samples. There was also evidence for the use of relaxation, music therapy, and reflexology for treating anxiety symptoms during active treatment, and that the use of hypnosis and aromatherapy using inhalation were of modest to some benefit during diagnostic or treatment procedures. Brittany Harvey: Understood. Thank you for reviewing those recommendations. And you already mentioned a few items that are helpful and recommended for adults with cancer experiencing anxiety post-treatment, but which additional integrative therapies are recommended for this patient population?  Dr. Julia Rowland: In addition to mindfulness-based interventions and yoga, acupuncture, Tai Chi, and/or Qigong, and reflexology are recommended for treating anxiety symptoms post-treatment.  Brittany Harvey: Excellent. Thank you for that summary of recommendations. So then, moving into the recommendations on depression, what does the expert panel recommend for adults with cancer experiencing symptoms of depression?  Dr. Julia Rowland: For depression symptoms during treatment, the panel recommended mindfulness-based interventions, yoga, music therapy, relaxation, and reflexology, while post-treatment mindfulness-based interventions, yoga, and Tai Chi or Qigong were recommended.  Brittany Harvey: Excellent. Thank you for reviewing all the recommendations that the panel put forward. So this guideline reviewed a large breadth of integrative therapies. Are there any therapies that the panel reviewed but couldn't make a recommendation for, for this particular guideline?  Dr. Julia Rowland: Thank you for asking that question because as people listen to this podcast, they may realize that there are some therapies that may be widely used by their population or in their center or clinic, including such things as natural products and supplements, melatonin, healing touch, massage, light therapy, to name a few. Where the panel found in its review of the literature of over 110 studies or systematic reviews, there was insufficient evidence for the vast majority of these to make any conclusive recommendation. It just means we have a lot more work to do in assessing the efficacy of these, especially in treating anxiety and depression.  One intervention stands out in particular that's widely used and that's expressive writing. While this may be very helpful for improving quality of life or making sense of the cancer experience and providing an outlet for self-expression, the data does not support its use for treating anxiety and depression. It may be because it's too brief an intervention for conditions that have more depth and permanence. It doesn't mean you can't use it for other purposes, but the panel did not recommend its use for treating anxiety and depression. Brittany Harvey: Understood. That makes sense that there are some integrative therapies that work across different parts of the treatment spectrum and that there are some areas in which we just don't have the evidence yet. So, thank you for reviewing all of those recommendations.  So then, how does this guideline complement the recently published ASCO Guideline on the Management of Anxiety and Depression in Adult Survivors of Cancer?  Dr. Julia Rowland: That's a terrific question. The recently published ASCO Guideline on Management of Anxiety and Depression in Adult Cancer Survivors represents an update of our original 2014 guideline. The ASCO guideline provided recommendations regarding the use of conventional therapies, psychological, behavioral, and psychopharmacologic interventions for managing anxiety and depression. The current SIO and ASCO guidelines sought to expand upon and essentially complement these recommendations by identifying those integrative therapies that might also be effective in the management of anxiety and depression in adults treated for cancer. Further, the SIO and ASCO guidelines attempted to determine when, in the course of care, during diagnosis and active treatment and/or post-treatment, these interventions worked best. Both sets of recommendations strongly endorse the benefits of mind-body interventions in addressing both anxiety and depression, specifically mindfulness-based interventions in this SIO and ASCO guideline and cognitive, behavioral, behavioral activation, and mindfulness-based stress management programs in the ASCO guideline. Brittany Harvey: It's great to have these complementary guidelines available at the same time for a complete approach to managing anxiety and depression during treatment and post-treatment. So then, in your view, Dr. Rowland, what is the importance of this guideline and how will it impact clinicians and patients with symptoms of anxiety and/or depression? Dr. Julia Rowland: Brittany, cancer takes a significant psychological toll on affected individuals. Research has shown that cancer survivors have a significantly elevated risk of developing mental health disorders compared with the general population. Despite this, their psychological symptoms are often under-recognized and undertreated. As the number of cancer survivors continues to grow, so does the challenge to healthcare providers of meeting their mental health needs. Anxiety and depression symptoms have long been associated with lower quality of life and higher mortality in people with cancer. Treating symptoms of anxiety and depression using evidence-based, integrative therapies has the potential to not only improve patients' quality of life and help them better manage their care but may also improve length of life.  With the publication of this guideline, we now know which therapies could have the biggest impact. An added benefit of incorporating, or at least considering, integrative therapies to manage anxiety and depression are that they have few, if any, side effects, can be readily modified to accommodate individuals with multiple comorbidities, are well received by the majority of patients, and can be received in a variety of settings, including at home and online. Brittany Harvey: Those are key points that you just made. These recommendations are key for improving quality of life for patients, and it's great to have options for patients, including, as you mentioned, at home.   So then finally, what are the outstanding questions for the use of integrative approaches in managing anxiety and depression in patients with cancer? Dr. Julia Rowland: As I look at these new guidelines, both the SIO and ASCO, as well as the renewed ASCO guidelines, perhaps the biggest question raised is how to increase the use of recommended care. And I think there are three parts to this challenge. One critical first part is raising awareness about these guidelines, which it's hoped this podcast will help us achieve. A second, equally critical step, however, is identifying available treatment resources. While most treatment clinics and centers have access to mental health resources in a number of settings, this may be quite limited. Further, it's not clear how many such programs include integrative programs and services.  In addition to the questions about availability, lack of familiarity with some of these therapeutic modalities may leave clinicians reluctant to refer their patients for such care and raise questions for them about how to assess the training and qualifications of integrative care providers and the rigor of the therapy they provide. An important recommendation made by both ASCO and the SIO and ASCO Anxiety and Depression Management Guideline panels is that oncology clinicians should conduct a landscape analysis of who is and what types of programs are available to provide the recommended therapies to their patients. Arguably, not knowing where to refer a patient suffering from anxiety and depression is the most significant area to that patient's receipt of optimal care. The landscape review should include in-house or affiliated mental health providers, integrative program leads if present, local professionals, and organizations offering this care, as well as access to community-wide and national groups providing integrative care remotely via online and telephone. Asking patients themselves who they have seen and found helpful in improving their emotional well-being can also broaden resource lists generated.   A third challenge is how best to identify and refer those patients most in need. Recommendations regarding screening and assessment of anxiety and depression were not within the scope of the SIO and ASCO guidelines. However, in the two published ASCO Guidelines on use of conventional interventions for managing anxiety and depression, both the 2014 original and the updated 2023 revised, the expert panels emphasize the critical need to routinely screen for both anxiety and depression using standardized measures such as the GAD-7 and the PHQ-9.  ASCO's QOPI or Quality Oncology Practice Initiative already includes screening for emotional distress early in the course of care as a key practice standard. Other appropriate times for screening include changes in disease or treatment status, transition to palliative and end-of-life care, and when clinically indicated. Screening is the critical and necessary first step to identification and referral for appropriate and timely care of cancer patients and survivors suffering from anxiety and depression. Figuring out how to do this well and systematically should be a priority for reducing the burden of cancer nationally. Brittany Harvey: Absolutely. As you mentioned, screening is critical for identifying patients experiencing anxiety and depression, and I appreciate you reviewing those implementation barriers and how clinicians and practices can work to reduce these barriers and increase the uptake of these recommendations. We'll have some of those resources linked in the guideline also on the ASCO website and in the show notes of this episode.  So I want to thank you so much for your insights on this guideline and for your time today, Dr. Rowland. Dr. Julia Rowland: My pleasure, Brittany. I hope the word gets out and we'll see more uptake of these affected therapies and in broader use. Thank you.  Brittany Harvey: Definitely. That's the goal of all of these guidelines.  I also want to thank all of our listeners for tuning into the ASCO Guidelines Podcast. To read the full guideline, go to www.asco.org/survivorship-guidelines.  You can also find many of our guidelines and interactive resources in the newly redesigned ASCO Guidelines app available for free in the Apple App Store or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast, and be sure to subscribe so you never miss an episode.  The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of medical conditions.   Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

https://swiy.co/WhatAreYourThoughtsWelcome to the Pediatric Meltdown podcast, where we delve into the challenges and triumphs of pediatric healthcare. Today, host Lia Gaggino has the pleasure of introducing her guest, (and self-proclaimed “superfan” of Pediatric Meltdown), Dr. Alisa Minkin, a trailblazing pediatrician and host of the JOWMA Podcast, a show dedicated to health education for the Orthodox Jewish community. In today's episode, Dr. Minkin shares her inspiring journey as a pediatrician and her unwavering commitment to mental health awareness. Drawing from her experiences as a parent to a child with special needs, as well as her advocacy for mental health screenings, Dr. Minkin's story is one of passion, resilience, and making a difference in the lives of children and families. Despite the barriers of time and limited resources, she has embraced telehealth as a double-edged sword and implemented crucial mental health screenings in her practice. Her desire to hear more voices of lived experiences, particularly from autistic and neurodivergent individuals and family partners, reminds us of the importance of inclusion and diverse perspectives in approaching pediatric care. Her journey serves as an inspiration for healthcare professionals and parents alike. With her passion and determination, she is indeed a true mental health warrior. So, grab your headphones and tune in to this episode – you don't want to miss this thought-provoking episode.The Spoons Theory: The spoon theory is a metaphor describing the amount of physical and/or mental energy that a person has available for daily activities and tasks, and how it can become limited. It was coined by writer and blogger Christine Miserandino in 2003 as a way to express how it felt to have lupus; explaining the viewpoint in a diner, she gave her friend a handful of spoons and described them as units of energy to be spent performing everyday actions, representing how chronic illness forced her to plan out days and actions in advance so as to not run out of energy.The metaphor has since been used to describe a wide range of disabilities, mental health issues, forms of marginalization, and other factors that might place an extra and often unseen burden on people living with them. From Spoon theory - Wikipedia[03:10 - 09:01] Barriers to meeting mental health needsLimited time for pediatricians to address mental health concerns during appointments.Lack of resources, especially for those who accept insurance or Medicaid.Challenges in finding qualified therapists and mental health resources.Disparities between Medicaid and private insurance coverage for mental health services.[09:02 - 14:24] Training Programs and Resources Case reviews and phone calls as part of the Reach programUtilizing Project Teach, a child psychiatry access programListening to podcasts, including the Joma and Pediatric Meltdown podcastsLearning from personal experiences and emotionally resonant stories[14:25 - 22:34] Personal Reflections and AdvocacyHighlighting the importance of suicide prevention and her sister's experience with it.Discussing the journey of implementing suicide prevention screening in her practice and allied supergroup.Expressing gratitude for the support received from experts in the field.Describing the introduction of combined ASQ Gad and PHQ screening tools in her practice.[22:35 - 32:47] The Importance of Advocacy and Creativity in...

What you'll get out of this episodeListen in as host Tim Fitzpatrick chats with Hillary Lin about Hillary's journey from launching Curio at the start of the pandemic to navigating their latest pivot into cancer care. Hillary's training and clinical experience led her to founding a holistic wellness startup that evolved into psychedelic-assisted therapy to where it is now as a comprehensive care delivery and navigation company. While Curio's vision has not wavered, the team's resilience and continued focus on patients has guided the evolution and expansion of their care infrastructure platform. In this episode you'll discover: What led Curio to provide supportive care to patients who have recently been diagnosed with complex chronic illnesses like cancer. How Hillary and her team have adapted their ketamine-assisted therapy treatments in this new model, and the outcomes they've seen from PHQ-9 and GAD-7 in as little as one month for patients using the assisted therapy. Why Hillary is hopeful that generative AI will revolutionize patient education in healthcare and make managing diagnosis easier to navigate. Why New York City is the place to build your health tech startup – Spoiler Alert: a community of familiar faces and fearless friends! Final Frontier - 5 Questions in 50 Seconds Top Challenge: The recent company pivot. When Curio changed the company vision, Hillary worked on rebuilding the relationship with partners and gaining new patients. Also, becoming in-network providers with insurance Top Opportunity: Building AI native care delivery. Tech Trend You're Following: VR/AR - New Apple VR headsets. Top Media Recs: Outlive by Peter Attia Healthcare / Tech Leader(s) You're Following:  Peter Attia  Eric Topol  Andrew Ying Quotables“In the beginning, I was so burnt out and frustrated with healthcare that I very much wanted to start a wellness company. What I mean by that, is we were coaching people to explore their emotions. From the basics of even labeling emotions and understanding mindfulness around your emotions to regulating them and to much more sophisticated ways of interacting using emotional language and expression. We even used to host improv classes to help people explore.” @HillaryLin #joinCurio on Ep37 @T-Minus10 w/ @trfitzpatrick. Recommended Resources We're redefining comprehensive care. We Are Overmedicated. How Can We Use Psychedelics To Heal Not Just Individuals, But Entire Systems?  DEA, SAMHSA Extend COVID-19 Telemedicine Flexibilities for Prescribing Controlled Medications for Six Months While Considering Comments from the Public  Join the ConversationHillary Lin on LinkedInHillary Lin on TwitterCurio on Medium“I am a physician and founder of a mental healthtech startup (Curio). So what are my thoughts on emotional chatbots? At the time of writing, I'm undecided because this realm is still developing as we speak. I think early versions of emotional support chatbots will not feel incredibly fulfilling or validating to most users. However, there is a world where people may be so socialized to AI entities that they will feel at home interacting with them. For now, I'm more interested in how AI can help us think and stay accountable to our own goals. More of a coach, perhaps, than a therapist. The New York Times published an article on Inflection AI's Pi companion, which seems to validate this feeling. "With a level of enthusiasm only a robot could muster before coffee, Pi pushed me to break down my to-do list to create a realistic plan. Like much of the bot's advice, it was obvious and simple, the kind of thing you would read in a self-help article by a productivity guru. But it was tailored specifically to me — and it worked.I'm curious to hear from people who have tried interacting with the latest emotional chatbots - what did you think about your experience?” (LinkedIn)“

AI and ML: What They are and How They Work Together?:Artificial Intelligence & Machine Learning: Catalysts for Positive Change or Culprits for Malice?Machine learning model accurately estimates PHQ-9 scores from clinical notesBest AI Games (2023): Some industry insiders claim that the most useful applications of artificial intelligence in video games are the ones that go under the radar. Artificial intelligence video games are always evolving. Each kind of game will use AI in its unique way.Google DeepMind AI discovers 70% faster sorting algorithm, with milestone implications for computing powerAI trial helps doctors spot early-stage breast cancerOne-Minute Daily AI News: Instagram, Singapore, EU, Deepmind, SQuld, Meta, Khan Lab School, Microsoft, LinkedinAttention AI Unraveled podcast listeners! if you have a Shopify Store get tinyEinstein for your email marketing. Using AI and a brief business description it grabs your store branding and quickly creates on brand weekly email campaigns, on brand email automations, and even on brand email sign up forms. All of your email marketing is DONE for the year in like 90 seconds thanks to tinyEinstein, your AI marketing manager. Go to tinyeinstein.ai or download tinyEinstein (all one word) from the Shopify App Store. Use code FirstM50AIPodcast to get 50% off your first month.Are you eager to expand your understanding of artificial intelligence? Look no further than the essential book "AI Unraveled: Demystifying Frequently Asked Questions on Artificial Intelligence (OpenAI, ChatGPT, Google Bard, Generative AI, LLM, Palm 2)," now available on Amazon, Google and Apple Book Stores.Get your copy on Amazon today!This podcast is generated using the Wondercraft AI platform, a tool that makes it super easy to start your own podcast, by enabling you to use hyper-realistic AI voices as your host.

Low testosterone in men is becoming a bigger problem with each passing decade. But what is the most significant cause of hypogonadism (the technical term for low testosterone)? It isn't diet. It's not environmental toxins or concussions, though they can affect a guy's levels. It isn't even drinking Bud Light. As you might surmise from the article's title, the most significant cause of low testosterone is circadian syndrome, a condition related to a disrupted circadian rhythm and sleep debt. A new study shows how much of a problem this is for American men. In this article, I'll discuss some of the key findings and what we can do about them. What is the prevalence of low testosterone? The most current research shows that 20-50% of U.S. males have testosterone deficiency.Kwong JCC, Krakowsky Y, Grober E. Testosterone deficiency: a review and comparison of current guidelines. J Sex Med. (2019) 16:812–20. doi: 10.1016/j.jsxm.2019.03.262 The cutoff for clinically diagnosed testosterone deficiency is a blood level 300 ng/dl, which is where the data comes from, suggesting that up to half of American men have low testosterone. In comparison, optimal testosterone levels are between 800-1200 ng/dl.  The problem is likely worse than that, as American men are less likely to get a checkup with their doctor than women, and even if they do, their doctors rarely check testosterone levels. What happens to men with low testosterone? Low testosterone leads to physical, mental, and sexual problems, including: Physical Changes: increased body fat, decreased muscle mass and strength, fragile bones, hot flashes, fatigue, and increased cholesterol levels.Mulligan, T., Frick, M. F., Zuraw, Q. C., Stemhagen, A., & McWhirter, C. (2006). Prevalence of hypogonadism in males aged at least 45 years: the HIM study. International Journal of Clinical Practice, 60(7), 762-769. Mental and Emotional Changes: changes in mood and mental capacity, including feelings of depression, irritability, trouble concentrating, and impaired memory.Shores, M. M., Sloan, K. L., Matsumoto, A. M., Moceri, V. M., Felker, B., & Kivlahan, D. R. (2012). Increased incidence of diagnosed depressive illness in hypogonadal older men. Archives of General Psychiatry, 61(2), 162-167. Sexual Dysfunction: reduced sexual desire, fewer spontaneous erections, and infertility.Khera, M. (2016). Male hormones and men's quality of life. Current Opinion in Urology, 26(2), 152-157. In many cases, as men develop any of these health problems, the health problems themselves lead to a greater decline in testosterone, which worsens the problems, which further tanks testosterone. You must break the downward cycle, and sleep is likely the most important place to start. What is Circadian Syndrome (CircS)? According to the study authors, CircS is primarily diagnosed based on hypertension, dyslipidemia, central obesity, diabetes, short sleep duration, and depression. Each of those symptoms is mainly governed by circadian rhythms, which are major regulators in almost every aspect of human health and metabolism. Association between the prevalence rates of circadian syndrome and testosterone deficiency in US males: data from NHANES (2011–2016) The Circadian Syndrome is diagnosed when a person has at least 4 of the following: Central obesity: waist circumference ≥102 cm (40 inches); High triglycerides (TG): TG ≥150 mg/dl or using TG-lowering drugs Low high-density lipoprotein cholesterol: high-density lipoprotein cholesterol

About Dale Cook:Dale is an expert in digital mental health. As co-founder and CEO of Learn to Live, he's part of a member-focused mental healthcare company that provides online programs and 24/7 clinician coaching to empower people to improve their mental health. Learn to Live serves over 33 million people through health plans, employers, and universities across the country.Dale has been recognized for his innovative approaches to healthcare as a recipient of the (Real) Power 50 award and the Business Leader in Healthcare: Startup award. Dale has been featured in various local and national publications, including Forbes, The Observer, National Public Radio, O, The Oprah Magazine, and others. Dale provides a welcoming and inspiring voice around mental health and the importance of driving engagement with digital healthcare solutions for at-risk populations.He is an active member of multiple healthcare entrepreneur groups focused on improving healthcare at the state and federal levels and is a member of the Governor's Taskforce on Broadband in Minnesota, which seeks to ensure quality broadband access for all Minnesotans. Dale is also a Fellow of the fifth class of the Health Innovators Fellowship at the Aspen Institute and a member of the Aspen Global Leadership Network. Things You'll Learn:Cognitive Behavioral Therapy programs have been studied for over two decades, and research shows that, when done correctly, digital CBT can be as effective as face-to-face CBT.Some necessary psychometric assessments are the PHQ-9 for depression, the GAD-7 for general anxiety, and the SPIN for social anxiety.Almost half of the people in the United States will suffer from a mental health problem at any point in their lives, but only one in four will seek care.Currently, teen mental health is one of the most important and talked about issues in this space.More than half of the counties in the US don't have a mental healthcare practitioner.Resources:Connect with and follow Dale Cook on LinkedIn.Follow Learn to Live on LinkedIn.Visit the Learn to Live Website!

Today is a very special episode because I not only have the pleasure of hosting this podcast, but I am also the guest. Yes, that's right! Today, in honor of Maternal Mental Health Month, I'm opening up my heart and sharing my postpartum story with you once again; I last told my story way back in Episode 1 in June 2016. I want all of you who know me as Dr. Kat professionally to understand why I am so deeply passionate about the cause of maternal mental health. Join us now! Karen Kleiman is a well-known international maternal mental-health expert with over 35 years of experience. As an advocate and author of several groundbreaking books on postpartum depression and anxiety, her work has been featured on the internet and within the mental health community for decades. In 1988, Karen founded The Postpartum Stress Center, a treatment and training facility for prenatal and postpartum depression and anxiety. Katayune Kaeni, Psy.D. PMH-C, “Dr. Kat,” is a perinatal mental health-certified psychologist, author of The Pregnancy Workbook: Manage Anxiety and Worry with CBT and Mindfulness Techniques, and host of the Mom & Mind Podcast, covering personal stories and expert interviews related to perinatal mental health. She is also the board chair of Postpartum Support International, an organization whose mission is to promote awareness, prevention, and treatment of mental health issues related to childbearing in every country worldwide. Dr. Kat began specializing in perinatal mental health after her own experience with postpartum depression, anxiety, and OCD over 12 years ago. Dr. Kat continues to work virtually with clients across California.  Show Highlights: How Dr. Kat's first pregnancy, even though planned and easy, resulted in a long, difficult labor that jump-started postpartum depression, anxiety, and OCD Why new moms struggle to know what's normal, not normal, too much, or not enough How feeling inadequate and incompetent as a new mom was part of Dr. Kat's anxiety and her battle with perfectionism How she felt alone and disconnected even from her husband, and NO ONE knew what was happening on the inside How scary intrusive thoughts put her in emotional turmoil Why shame and stigma are greater for mental health professionals–and will silence them at times How Dr. Kat carried on her therapy work with clients as the depression grew, making her feel trapped, exhausted, embarrassed, and confused How finally taking the PHQ-9 depression screening test for herself finally opened her eyes to the truth of what she was going through How she shut down even with her therapist and turned to a naturopathic physician, acupuncture, and other healing alternatives Why therapists MUST address the suffering client in front of them with curiosity and questions Why Dr. Kat is so deeply driven to help other moms break through and find the help and support to know that THEY WILL BE OK Resources: Connect with Karen: Website, Twitter, Instagram, Facebook, Book: Good Moms Have Scary Thoughts and LinkedIn Check out Karen Kleiman's other books: Website and Amazon Visit www.postpartum.net for resources and support!  Visit www.postpartum.net/professionals/certificate-trainings/ for information on the grief course.   Visit my website, www.wellmindperinatal.com, for more information, resources, and courses you can take today! Learn more about your ad choices. Visit megaphone.fm/adchoices

https://302.buzz/PM-WhatAreYourThoughtsAggression in children is a complex issue that can leave parents feeling helpless and desperate for a solution. Many turn to medication as a quick fix, but according to Dr. Lia Gaggino's guest, Dr. Peter Jensen, multiple medications are not always the answer. It's important to assess the situation correctly and consider alternative approaches before turning to medication. In this episode, Doctors Gaggino and Jensen explore the various causes of aggression in children and provide tips on how to handle it effectively without resorting to excessive medication. Whether you're a parent, caregiver, or educator, the information provided in this episode can help you better understand aggression in children and how best to support them. Get your pad and pencils ready, you'll be taking notes on this one. [00:30 -27:46] Understanding the Different Types of Aggression in Children and How to Treat ThemThe Importance of Assessing and Diagnosing before Prescribing MedicationAggression in children can fall into different categories, such as chronically irritable and explosive or misinterpreting social cuesDiagnostic Skills Help in Identifying the Underlying Causes of Aggressive Behaviors in ChildrenBipolar disorder and schizophrenia are unlikely causes of aggressive behavior in children[27:47- 38:02] Understanding and Treating Aggressive Behaviors in Children Treatment for ADHD should be maximized before turning to other medicationsResperidone and Aripiprazole have been approved by the FDA to treat aggression in childrenPrimary care providers need to get comfortable with atypical medications Guidelines for treating maladaptive aggression in youth are available in the journal Pediatrics[38:03 -48:14] Evaluating Medication for Children with Mental Health DisordersTrauma should be considered when treating children with psychiatric medications.Avoid the "pharmacotherapy of desperation," which involves adding multiple medications without clear rationale. Deprescribing, or slowly decreasing medication use, can be helpful for children on multiple medications that may not be effective.A thorough evaluation of the underlying disorder, using rating scales and input from multiple sources, is essential for choosing the right medication.[48:15 - 57:06] Top Screening Tools for Child Mental HealthVanderbilt Rating Scale is essential for monitoring ADHD in kids on stimulantsPHQ-9 is a quick and free depression scale that is recommended by the US Preventive Services Task Force and Academy of PediatricsSCARED is an effective tool for tracking and screening anxiety in children and can be given to parents or youthPSC-17 is ideal for well-child visits as it has only 17 items and screens for inattention, ADHD, anxiety, and depressionSuicide specific tools like ASK Screening Questions and Columbia should be used alongside PHQ-9 for better screening of suicidal ideation and behavior; CRAFFT can be used to screen for substance use in teenagers. [57:07 - 1:04:54] Closing segment TakeawayYou can reach Dr. Peter JensenWebsite: https://thereachinstitute.org/LinkedIn:

Dr. Barbara Andersen delves into the newly updated guideline for management of anxiety and depression in adult survivors of cancer in this ASCO Guidelines podcast episode. This guideline affirms prior guidance regarding screening and assessment of anxiety and depression, and updates evidence-based recommendations for management of both anxiety and depression. Dr. Andersen reviews the principles of the recommended stepped-care model, along with recommended treatments, including options such as cognitive behavior therapy, cognitive therapy, behavioral activation, structured physical activity and exercise, and mindfulness-based stress reduction. Challenges regarding managing anxiety and depression in adult survivors of cancer are also discussed. Read the full guideline update, “Management of Anxiety and Depression in Adult Survivors of Cancer: ASCO Guideline Update” at www.asco.org/survivorship-guidelines. TRANSCRIPT This guideline, clinical tools, and resources are available at www.asco.org/survivorship-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest disclosures in the Journal of Clinical Oncology, https://ascopubs.org/doi/10.1200/JCO.23.00293. Brittany Harvey: Hello and welcome to the ASCO Guidelines Podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges, and advances in oncology. You can find all the shows, including this one, at asco.org/podcasts.  My name is Brittany Harvey, and today I'm interviewing Dr. Barbara Andersen from the Ohio State University, lead author on “Management of Anxiety and Depression in Adult Survivors of Cancer: ASCO Guideline Update.”  Thank you for being here, Dr. Andersen.  Dr. Barbara Andersen: Thank you. Thank you for the invitation. Brittany Harvey: And then, just before we discuss this guideline, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Andersen on this episode, are available online with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes.  So then, to jump into the content of this guideline, Dr. Andersen, what prompted an update to this guideline, and what is the scope of this updated version of the guideline?  Dr. Barbara Andersen: Well, as your listeners probably know, guidelines are routinely updated, primarily due to new accumulated evidence that suggests a change in diagnostic or treatment procedures. The first guideline from ASCO was in 2014. They made this important first step, which alone made that an important advance. The prior scope was on assessment, that is, which measures at what time points were important for assessing patients' depressive or anxiety symptoms. We then provided treatment pathways thereafter, noting currently available evidence for treatment. But a systematic review of the literature wasn't done at that time. So what this guide does is first affirm the prior recommendations regarding the measures to use for assessment, the PHQ-9 and the GAD-7. But the departure for these guidelines is based on a systematic review of the intervention and treatment literature, and from that review, we recommend particular treatments. Brittany Harvey: Understood. So, focusing on that intervention and treatment aspect of this updated guideline, I'd like to review the key recommendations starting with, what are the key general management principles for people with cancer and anxiety and/or depression?  Dr. Barbara Andersen: Well, one key principle is that of education. Your listeners probably are familiar with the fact that many hospitals or centers provide patient-tailored cancer treatment-related information, treatment information on surgery, chemotherapy, immunotherapy, and other topics. But we recommend that general first-level materials on coping with stress, anxiety about treatment, and depression be routinely provided as well. What that does is for individuals with elevated symptoms, it validates what they're experiencing and normalizes the patient experience. So we hope that all patients with cancer and any patient-identified caregiver, family member should be offered the information. We have so many ways we can give information to patients these days. Verbally, material, whatever mode is easy for you and the patient, but please choose one to give information to patients.  Another characteristic of the guideline is our recommendation that treatment follow the principle of stepped care. So what this means is you match the assessment of the severity, level of depression or anxiety, and you match that data to the selection of treatment contexts. This is most clearly seen in the recommendation that group treatment formats be used for those with moderate severity of symptoms versus individual or face-to-face therapy for those with severe symptoms. And this is the case for both anxiety and depressive disorders. This is a principle that's cost-effective and tailors the treatment recommendations. Another principle that we offer is when making a referral of a patient for further evaluation or psychological care; we plead with you to make every effort to reduce the barriers and facilitate patient follow-through. We say it's essential because low motivation, for example, is a symptom of depression. And that low motivation and low mood can conspire to reduce the likelihood that patients will pursue treatment. So just keep that in mind when referring patients.  Brittany Harvey: Absolutely. Those are key points for general management across anxiety and depression symptoms. So, moving beyond those principles, what are the recommendations from the expert panel for treatment and care options for patients with depressive symptoms?  Dr. Barbara Andersen: For depressive symptoms, we recommend cognitive behavior therapy or cognitive therapy, behavioral activation, psychosocial interventions using empirically supported components, and moderate structured physical activity and exercise. All of those are efficacious, empirically supported treatments for moderate depressive symptoms. And it might be easiest to offer group therapy for individuals with these problems.  Brittany Harvey: Great. Thank you for reviewing those recommendations for patients with depressive symptoms.  So, in addition, what does the expert panel recommend for treatment and care options for patients with anxiety symptoms?  Dr. Barbara Andersen: Many of the same treatments are used. Cognitive therapy, cognitive behavior therapy are the most efficacious treatments out there for cancer patients or individuals without cancer coping with anxiety symptoms or depressive symptoms. Again, behavioral activation would be useful. Mindfulness-based stress reduction has garnered significant support in the recent years, as well as interpersonal therapy.  Brittany Harvey: Understood. So thank you so much for going through each of those recommendations.  But in your view, Dr. Andersen, what is the importance of this guideline, and how will it impact both clinicians and patients with cancer and symptoms of anxiety and/or depression?  Dr. Barbara Andersen: An important element to this guideline is it names the specific empirically supported standard therapies for treatment of anxiety and depression. There's a departure, though, from our prior guideline, and in this one, pharmacotherapy is not recommended as a first-line treatment, neither alone nor in combination. It's simply not supported by the evidence. However, clinicians might consider pharmacotherapy when there's low or no availability of mental health resources. Perhaps a patient might have responded well to pharmacotherapy in the past, and patients with severe neurovegetative, or agitated symptoms of depression, those patients, as well as patients with psychotic or catatonic features, would be ones for which pharmacotherapy might be appropriate.  Brittany Harvey: Understood. And then you've just mentioned that sometimes there is no or low availability of mental health resources, so that leads to my next question. But what are the both outstanding research questions and challenges regarding managing anxiety and depression in adult survivors of cancer?  Dr. Barbara Andersen: The largest challenge is that we're in the midst of a mental healthcare crisis, and COVID has made that abundantly clear. There are problems with access to psychological care due in part to workforce problems, maybe organizational ones, but there is a shortage of mental health professionals, and that, in turn, limits referral networks from managing depression and anxiety. So that's one significant issue that is in place right now.  Since the 2014 guideline, screening is a care aim that has been disseminated, but the principles and procedures remain to be fully implemented. I was just looking at a 2022 article in the Journal of Oncology Practice. It was a study examining screening for lung and ovarian cancer patients, two very important groups because the frequency of depressive and anxiety symptoms is perhaps highest of any other groups. So they looked at more than 20 CoC-accredited facilities that studied the electronic records to see if there was screening for the patients. And the troubling finding, from my perspective, was that there was no screening for 45% of the patients in this study. So we know that there are disparities in the use of screening and its management. Those disparities exist across race, ethnicity, cancer type, stage, and facilities. And so, that remains a challenge for many sites, including CoC hospitals, to achieve a rigorous screening program. Having said that, I want to say what some might disagree with, but from my standpoint, it's a myth that screening takes a long time. The measures that we recommend probably would take a patient maybe five, maybe ten minutes to complete. But what's time-consuming or what's troublesome in many places is the infrastructure is not in place to do the screening and interpret it in an efficient manner. The other perspective on screening is that it is the effort thereafter, which is, in fact, time and resource intense - that is, finding referral sources, making referrals. But that's the most important step because when that's not done, when patients continue with symptoms, it really incurs the greatest cost for the patients. Brittany Harvey: Absolutely. Screening and then further management of anxiety and depressive symptoms is key for maintaining quality of life.  So I want to thank you so much, Dr. Andersen, for coming on today and sharing your insights and also for all your work you did to update this guideline.  Dr. Barbara Andersen: Thank you so much. Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO Guidelines Podcast.  To read the full guideline, go to www.asco.org/survivorship-guidelines. You can also find many of our guidelines and interactive resources in the newly redesigned ASCO Guidelines app, available for free in the Apple App Store or the Google Play Store. If you've enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe, so you never miss an episode.  The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.      

Interviewer info Lyssa Rome is a speech-language pathologist in the San Francisco Bay Area. She is on staff at the Aphasia Center of California, where she facilitates groups for people with aphasia and their care partners. She owns an LPAA-focused private practice and specializes in working with people with aphasia, dysarthria, and other neurogenic conditions. She has worked in acute hospital, skilled nursing, and continuum of care settings. Prior to becoming an SLP, Lyssa was a public radio journalist, editor, and podcast producer. In this episode, Lyssa Rome interviews Kristin Schaffer Mendez about her work on counseling for people with primary progressive aphasia and their families.   Gap Areas This episode focuses on Gap Area #6, insufficient attention to depression and low mood for people with aphasia across the continuum of care.   Guest info   Dr. Kristin Schaffer Mendez is a speech-language pathologist and assistant professor at the University of St. Augustine in Austin, Texas. Prior to entering academia, she worked in several clinical settings, including inpatient rehabilitation, home health, and private practice. Dr. Mendez's experience as a clinician has inspired her research, which is centered upon examining and addressing psychosocial factors in acquired neurogenic communication disorders through patient-centered and care partner-inclusive treatment paradigms, including counseling, support groups, and the use of telerehabilitation platforms.   Listener Take-aways In today's episode you will: Learn about some of the psychosocial factors that people with primary progressive aphasia may face. Understand how speech-language pathologists can provide both educational and personal adjustment counseling for people with PPA. Describe a cognitive behavioral approach to personal adjustment counseling for people with PPA. Edited show notes Lyssa Rome Welcome to the Aphasia Access Aphasia Conversations podcast. I'm Lyssa Rome. I'm a speech language pathologist on staff at the Aphasia Center of California, and I see clients with aphasia and other neurogenic communication impairments in my LPAA-focused private practice. I'm also a member of the Aphasia Access Podcast Working Group. Aphasia Access strives to provide members with information, inspiration, and ideas that support their aphasia care through a variety of educational materials and resources.   I'm today's host for an episode that will feature Dr. Kristin Shaffer Mendez. Dr. Schaffer Mendez is a speech language pathologist and assistant professor at the University of St. Augustine in Austin, Texas. Prior to entering academia, she worked in several clinical settings, including inpatient rehabilitation, home health, and private practice.   Dr. Schaffer Mendez his experience as a clinician has inspired her research, which is focused on examining and addressing psychosocial factors in acquired neurogenic communication disorders through patient-centered and care partner-inclusive treatment paradigms, including counseling support groups, and the use of telerehabilitation platforms. In this episode, we'll be focusing on her research on counseling for people with primary progressive aphasia.   Dr. Kristin Shaffer Mendez, welcome to the Aphasia Access podcast. It's great to have you here.   Kristin Shaffer Mendez  Thank you so much for having me. It's wonderful to be here.   Lyssa Rome  So I wanted to get started by asking you a question that we often start with, which is whether you have any “aha” moments, so experiences that were pivotal for you in your work as a clinician or as a researcher?   Kristin Shaffer Mendez Yeah, you know, I think throughout my career, there have been a series of “aha” moments. If I think through my career, I've had several different stages. So initially working clinically, as a speech language pathologist, as I was partnering with patients with all different types of communication disorders and their families, I quickly realized that we weren't going to address the specific speech language goals if I didn't first acknowledge and check in with these individuals and get a sense of their general wellbeing, and a sense of if they were suffering, if they were grieving, if they were going through or processing something specific. I did have some didactic training as a student and counseling—not a lot—and I noticed when I would try to find evidence-based resources, I wasn't finding a lot of disorder-specific counseling information.   Fast forward a few years later, I was working as a research speech language pathologist at the Aphasia Research and Treatment Lab in Austin, Texas. And I was working primarily with individuals with PPA, and sometimes I would notice, and in the midst of a speech language treatment session, they would say something maybe under their breath, or maybe in frustration, like, “Oh, my dumb brain,” or “ I'm such an idiot.” And I was thinking, oh, goodness, if this is what's coming out of their mouth, I only wonder what what's happening behind the curtain. And if we were to look at the inner workings of their mind, what their self talk would look like, and how critical it might be. Then I was thinking, “Okay, now what what types of tools might I be able to provide for these individuals so that they can minimize that critical voice, and be more positive, be more adaptive.” And so that leads me to to my line of research.   Lyssa Rome And that also leads, I think, straight into the gap areas. So in this podcast, we've been highlighting those gap areas that were identified in the State of Aphasia Report by Nina Simmons Mackie, which was published in 2018. And I think, in this episode, what you've described so far, and what we're going to be talking about, really focuses in on gap area number six, which is insufficient attention to depression and low mood for people with aphasia across the continuum of care.   You described some of the kinds of self-talk that you were hearing people say. I'm wondering if you could tell us a little bit more about the kinds of psychosocial issues that people with primary progressive aphasia typically experience. And I guess I also wonder if this differs at all from what people with post-stroke aphasia experience?   Kristin Shaffer Mendez So individuals with primary progressive aphasia, the psychosocial factors that they're facing can range from feelings of low confidence, to social isolation, withdrawal, reduced participation in life activities to a diagnosis of mood and or anxiety disorder. So similar in many ways to what individuals with stroke-induced aphasia may be facing. But the difference here is that when we look at the prognosis and the trajectory of life for individuals with PPA, in contrast to individuals with stroke-induced aphasia, who can look at a future of improved communication functioning, or maybe an plateau in communication status, for individuals with primary progressive aphasia, their trajectory is that of decline. And so these individuals are at particular risk for facing these psychosocial threats and for these factors to change over time as well.   Lyssa Rome  So given some of these needs that you've just described and the risks that you've described, how can we as speech language pathologists provide counseling in our treatment for people with PPA?   Kristin Shaffer Mendez   Yeah, so there's there lots of different avenues that we can go down in terms of providing counseling, and really what I'll say is, this is going to be person-specific, and we'll tailor our counseling to the needs of an individual, session by session.   There are two main camps in terms of counseling within our field more broadly, in communication sciences and disorders. And this I follow from Dr. David Luterman, of course, one of the long-standing advocates and pioneers for the integration of counseling in our field. He cites two main forms of counseling. One is informational counseling, otherwise known as psychoeducation, or educational counseling. This is where we're providing disease-related information. And then there's personal adjustment counseling. This is going to be more emotion-centered. This is where we are directly addressing those thoughts, feelings, and behaviors underlying the diagnosis. So I really do believe that we can toggle between the two, and that our patients can and may benefit from both forms of counseling.   As a field, research has shown that speech language pathologists tend to feel more comfortable in providing the educational or the informational counseling relative to personal adjustment counseling, and they're also more likely to have been provided with didactic education in that information-centered counseling. But this is this is where my work comes in. And this is where I'm really motivated and invested in in making changes.   I'll talk some more about personal adjustment counseling. So this can range from micro-counseling skills, that are more general, and that are those soft skills that will help to foster a strong therapeutic alliance with our patients. So actively listening, listening without having an agenda of what we're going to say next, or thinking about the time and redirecting back to the speech language treatment task. Having moments of therapeutic silence, where again, we're not jumping in to fill empty space, but pausing a beat, and letting the patient continue to talk, or sit for a moment and process. Paying attention to our body language, the nonverbal way that we're communicating, leaning in, nodding, validating, affirming through the way that we are presenting. And then listening to what our patients are saying, and then thoughtfully summarizing. So letting our patients know that they are seen and heard and validated.   So those are, those are microcounseling approaches, and we can provide that anytime with any of our patients or our care partners. But then there are also specialized counseling approaches, and that's where my research really delves into further that are going to require more training and a specialized set of skills.   But really, in terms of our opportunities to provide counseling that can really be organically woven into our interactions from the very initial assessment throughout treatment, checking in with our patients at the beginning of sessions, at the end of sessions, and just being being aware, being observant, and noticing if there are moments when our patients seem to be undergoing a moment where they want to talk and where we might need to pause. And use that moment as as a teachable counseling opportunity. And not feel as though we need to stringently adhere to our speech language treatment sessions, or that we have to have some formal time in our sessions that's set aside for counseling.   Lyssa Rome    It almost sounds like you're describing approaching our treatment sessions with a counseling mindset that sort of is woven throughout. And you alluded to more specialized programs that we can also use. I know you've developed a cognitive behavioral therapy program for people with PPA, and I'm curious about that program, and about why you selected CBT. And maybe if you could define it a little bit?    Kristin Shaffer Mendez Absolutely. Yes. So cognitive behavioral therapy, or CBT, is one of the most widely researched and popular forms of psychotherapy. And it trains individuals to examine the connection amongst thoughts, feelings, and behaviors in order to identify, assess, and respond to maladaptive or unhelpful thoughts to optimize mood and behavior more broadly. And also CBT has been modified for individuals with a variety of diagnoses, including those with neurodegenerative disorders, such as Alzheimer's dementia. So when I was considering different psychotherapeutic approaches to adapt, it really seems like CBT could could be a great starting point. There's really limited research in general about adapting counseling approaches for this population.   So within this treatment program, there were both opportunities for dedicated counseling, and that counseling closely followed the traditional form of CBT. However, the sessions were oriented towards communication-centered challenges. And so within that, there's opportunities to check in on an individual's mood, and talk through a home practice exercises from the last week, check in on that, and talk through, “Okay, so what what types of communication difficulties came up this week? And then how we should we prioritize our time together? What do we need to work through?” Then working through specific challenges using aphasia-modified CBT approaches and, and then ending with a feedback component as well. So that's basically the gist of a traditional CBT approach, as a CBT session. So there was that component, but also, these sessions were aphasia-modified in that aphasia-friendly written and visual supports were provided as needed to ensure comprehension of these key CBT concepts that could be new new terminology for any individual who's entering a counseling dynamic. We just wanted to make sure that these individuals were provided with that support.   But so in addition to the more structured counseling, there were also opportunities organically within the speech-language portion of the treatment sessions, where if an individual was demonstrating frustration or emotional distress, or they were saying statements that were maladaptive in nature, then these were teachable counseling moments where CBT techniques were used within the session.   Lyssa Rome So can you tell us a little bit more about the clients goals and also about what you found?   Kristin Shaffer Mendez Yes, absolutely. So, first, I want to contextualize this research and mention that it is considered pilot research. So this is early phase, early stage research, where we are looking at answering the question: Is this novel intervention feasible and is it acceptable to patients? So we're obtaining information to see if patients were satisfied by the treatment, if this was feasible for a speech language pathologist to implement. What we're finding with a small cohort of individuals, so we've published one paper in the American Journal of Speech Language Pathology with our very first pilot participants, that was just a single case experimental design. We have nine additional individuals, three per PPA variant, who have participated in our second phase of pilot research and we have a manuscript in preparation for that stage. But what we're finding today is that this intervention is acceptable. And it's it's feasible. We were also really intentional in selecting and recruiting and enrolling individuals who did endorse that, in light of their PPA, of their communication challenges, that they were facing threats to their emotional well-being and that they were interested in participating in an intervention that included counseling.   So I think that's one important point to make when looking at the individuals who have undergone this intervention. Then with regard to goals, that was really individual for each person. It ranged from participating more in prayer groups to calling family members or friends instead of emailing them or not picking up the phone out of a sense of a fear of what would happen during the conversation. And yes, so these goals were all created collaboratively with with me as the clinician and with the participant, to really determine what was going to be meaningful and valuable in these individuals lives and what to work towards, collectively and in our time together.   Lyssa Rome That makes so much sense and I can imagine how addressing some of the psychosocial challenges, as you have described them, would would allow people to participate in the ways that you were just detailing.   I'm curious about.. you mentioned earlier on, that we don't always get a lot of training as SLPs in specific counseling approaches, and often are more comfortable, I think, with the educational counseling piece of things. So what kind of training would clinicians need—both future clinicians and current clinicians—in order to use this type of approach with our clients?   Kristin Shaffer Mendez Yeah, that's, that's a great question. And that's what we're continuing to examine, as we continue to move through our phases of research and so we've now completed pilot research and in the future we're looking at efficacy research and and later on down the line, I can say more generally, what I envision is that these types of counseling approaches and the evidence base wherein, that we discover, will then be incorporated more universally in graduate school education. But not so that, necessarily, students are going to graduate being able to implement and provide these specialized counseling approaches, but so that they have a sense of the theoretical underpinnings and the basic constructs of these approaches, and even thinking about patient candidacy—who might be appropriate and who might benefit from these approaches. But then in the future, I can see there being continuing education opportunities similar to LSVT, the Lee Silverman approach, where maybe it's a two-day training, for example, and intensive training where individuals are provided with a lot of hands-on experiential learning, so that they are equipped with those tools that they can then implement with patients.   Lyssa Rome  It brings to mind another question that I have, which I think is often on my mind anyway, when I think about counseling approaches, which is: We know that a lot as you've been describing, a lot of anxiety or mood related challenges are directly related to communication-specific disorders, in this case, PPA. So as we think about the needs, the psychosocial needs of people with PPA, given that so many of those needs are directly related to this progressive communication disorder, how do we know what's within our scope, and when we might consider referring to a mental health professional, for example, if the needs are greater than what we are able to meet on our own?   Kristin Schaffer Mendez That's a great question. And I do believe as speech language pathologists we're uniquely equipped to providing counseling. We are the communication experts. And we possess specialized skills in understanding individuals with communication impairments, and helping them express themselves. And this is something that a lot of licensed mental health professionals may not have the background training and experience in.   So with regards to determining when to potentially refer, so it's completely normal, we would argue, that individuals facing a neurogenic communication disorder, such as PPA will, will likely experience grief and loss and suffering as they're processing their diagnosis and navigating their days. But if we have a sense that they are presenting with a mood and or anxiety disorder that may be undiagnosed, then certainly the first step is to administer a mental health screening or an anxiety disorder screening, there are several available online that are free—the Personal Health Questionnaire, the Generalized Anxiety Disorder Scale, for instance. And then if the results do show that there is the potential presence of mood or anxiety disorder, then having having a conversation and coming from a place of care and concern and letting our patient know that we do have concerns that these individuals may be presenting with challenges that go beyond what we are able and equipped to provide. And then from there, looking into finding mental health professionals within the community, so that we can give that warm handoff and engage in interprofessional collaboration, if need be, if the mental health professionals maybe don't have experience in treating a client with PPA or aphasia, for example.   Lyssa Rome  And that's, I think, a perpetual challenge, right? It's finding those people who can support clients with mental health needs beyond what we're able to help them with—people who have those those kinds of communication skills and experience.   Kristin Schaffer Mendez And if I could just say one other thing as well. When I said a warm handoff, I don't necessarily mean that we stop treating our patient or that we don't continue to provide counseling. It's just we want to make sure that we're staying in our lane and providing counseling as it relates to the communication challenges. But not going beyond and stepping outside, especially if there's some type of mental health disorder that needs to be treated and managed more broadly.   Lyssa Rome That totally makes sense to me. It's working with the mental health counselor and not instead of.   So we know that people with PPA will continue to experience declines in their language functioning as their disease progresses. I'm wondering about how the counseling needs change over time and how we can meet their needs over time, as their disease progresses?   Kristin Shaffer Mendez   Yes, that's that's a great question. And that's really important too, is that we demonstrate flexibility, both in the counseling that we provide and in the speech language interventions we provide that's really yoked to and sensitive to a person's presentation.   So Dr. Ian Kneebone has published work pertaining to the provision of CBT for individuals who have survived a stroke. And I think that the principles that he discusses would be really applicable for individuals with PPA or other communication impairments as well, in that we must demonstrate flexibility, that is yoked to an individual's cognitive and communication presentation. And so if, for example, an individual, we'll say with PPA, is presenting with a more progressed clinical profile, then we would consider using language that's more concrete versus more abstract. We would also consider the provision of additional environmental supports, or multimodal communication, for example. And we would also want to include our care partners, if they are amenable to participating, as that can then help to ensure facilitation and implementation of the strategies outside of the therapy sessions.   Lyssa Rome    That brings me to another question, which is that you had mentioned earlier in a study that hasn't been published yet, you had people with each variant of PPA involved in your research. And I'm curious about sort of, in addition to thinking about disease progression, if there are also aspects of the variants that clinicians should be aware of in terms of their neuropsychological or behavioral features. And how would we want to think about sort of varying strategies based on those features? Or what to expect even based on those features?   Kristin Shaffer Mendez Absolutely, yes, that's a great question. And I think that being aware of the potential presence of these neuropsychiatric and behavioral features is important in general, because this can also influence the speech-language interventions we provide. There has been research that have has shown some general patterns that we might expect to see across the PPA variants. So for example, apathy has been found in some research studies, and then other other features that are more specific to a specific PPA variant. So, for example, with the semantic variant of PPA, we may see loss of empathy, mental rigidity, compulsive behaviors, disinhibition. With the logopenic variant, we may see agitation, anxiety, irritability, and with the nonfluent, agrammatic variant, we might also see irritability, and these individuals also often may present with depression. So you know, those are those are some some general trends that we've seen. But again, we have to look at each person as an individual.   But in terms of the counseling that we provide, yes, I think that if we have an individual that, for example, has the semantic variant of PPA, and they're presenting with mental rigidity, then thinking about what types of counseling may resonate with them, or what types of counseling may need to be provided to family members and care partners will be important to consider. So for example, with with cognitive behavioral therapy, which is really hinged upon cognitive restructuring, and taking thoughts that are unhelpful or maladaptive and monitoring and adjusting them so that they become more helpful and adaptive. If somebody presents with mental rigidity, then this type of intervention may be met with resistance.   That said, for the very small sample size of individuals I've worked with, that hasn't always necessarily been the case that that these individuals were not open to engaging in a counseling approach like this. Really small sample sizes—we really can't make any sweeping statements at this point in time. But I think that the key is that we are aware of these features, and that we are providing counseling and educational support and that we are flexible. And sometimes, an approach may not work in general, sometimes it may not work a specific day, and so this really requires trialing and error and experimentation and openness on the part of both the clinician and the client.   Lyssa Rome That leads me actually directly into a question that I wanted to ask as we wrap up. I think it is so important to meet people where they are on a specific day, and to be really aware of who they are and what they're experiencing as an individual—I think that's pretty core to many of our, all of our practices as speech language pathologists. I wanted to wrap up by taking a step back and asking you a little bit more about why this is so important. You touched on it in the beginning, but how does counseling support a life participation approach for our care for people with PPA?   Kristin Shaffer Mendez Yes, so the orientation with counseling is within the context of a whole person who lives a rich, dynamic life. And these individuals are unique, and they have different values and goals. And they do have a communication impairment, but that's just one part of their life, and doesn't define them as a person. And so within the work that we do, in providing counseling, we are honoring these individuals and and that full landscape of their life. And we're equipping them with skills so that they can cope with the challenges that they are facing with their communication challenges. So that they can continue to live a meaningful life that aligns with their values and their goals for their time on this earth.   Lyssa Rome What I'm moving and beautiful way to wrap this up. Dr. Kristin Shaffer Mendez, thank you so much for talking with us. I really appreciate it. It's been a pleasure.   Kristin Shaffer Mendez Oh, it's been a pleasure as well. Thank you so much for the opportunity.   Lyssa Rome Thanks also to our listeners. For the references and resources mentioned in today's show, please see our show notes. They're available on our website, www,aphasiaaccess.org. There, you can also become a member of our organization, browse our growing library of materials and find out at the Aphasia Access Academy. If you have an idea for a future podcast episode, email us at info@aphasiaaccess.org. Thanks again for your ongoing support of Aphasia Access. For Aphasia Access Conversations, I'm Lyssa Rome.       Twitter: @Schaffer_SLP References and Resources Twitter: @Schaffer_SLP   Luterman, D. (2020). On teaching counseling: Getting beyond informational counseling. American Journal of Speech-Language Pathology, 29(2), 903–908. https://doi.org/10.1044/2019_AJSLP-19-00013 Schaffer, K. M., Evans, W. S., Dutcher, C. D., Philburn, C., & Henry, M. L. (2021). Embedding aphasia-modified cognitive behavioral therapy in script training for primary progressive aphasia: A single-case pilot study. American Journal of Speech- Language Pathology, 30(5), 2053–2068. https://doi.org/10.1044/2021_AJSLP-20-00361 Kneebone, I. I. (2016a). A framework to support cognitive behavior therapy for emotional disorder after stroke. Cognitive and Behavioral Practice, 23(1), 99–109. http://doi.org/10.1016/j.cbpra.2015.02.001   Screening tools and citations: PHQ-9: K. Kroenke, R.L. Splitzer, J.B. Williams. “The PHQ-9: validity of a brief depression severity measure.” Journal of General Internal Medicine. 16(9): 606-13. September 2001. Retrieved July 9 2018. https://www.ncbi.nlm.nih.gov/pubmed/11556941.   GAD-7: Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of International Medicine, 166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092  

In this episode, Luke Freeman interviews Sean Mayberry, the CEO of StrongMinds, a non-profit organization that provides group talk therapy to people in low-income countries to improve mental health. Sean shares his background, including his journey from working as a diplomat to founding StrongMinds, and his experiences with depression. He also explains the importance of mental health and the problem of depression across Africa, where over 66 million women suffer from depression but only 15% have access to care. Since 2013, they've treated nearly 175,000 women in Uganda and Zambia. Sean highlights the impact of depression on families, the need for effective interventions, StrongMinds plans for growth and more.   CHAPTERS: 00:00 - Introduction to Sean and his journey to founds StrongMinds 03:48 - Why focus on depression? 07:57 - The scale of mental illness in low and middle income countries (LMICs) 10:12 - What causes depression in LMICs? 12:25 - StrongMinds treatment model and how it works 15:16 - The diagnostic scale PHQ-9 18:15 - How do you remove bias from measurement? 20:10 - The indirect benefits of treating depression 21:58 - Why has StrongMinds focused on treating women? 23:35 - Comparisons to cash transfers by Happier Lives Institute 25:50 - How Sean's experience in HIV/AIDS informs StrongMinds program delivery 27:48 - Why is mental health still overlooked? 30:06 - Scaling funding and reaching more donors 31:42 - The biggest challenges implementing effective mental health interventions globally 33:17 - Lessons learned in adapting to different demographics 34:50 - How is the team structured 36:25 - Why is group talk therapy rate in places like Australia and the US? 40:33 - What are Sean's proudest moments with StrongMinds? 42:30 - Elevator pitch and closing comments   CREDITS: Production: Grace Adams Video editor: Marco Shimabukuro Interviewer: Luke Freeman Guest: Sean Mayberry

Drs Madhukar Trivedi and Manish Jha discuss the use of a "primary care first" model to screen and treat depression, emphasizing measurement-based care that can triage to specialty care when needed. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/984454). 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 USPSTF Screening for Depression in Adults https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/depression-in-adults-screening Depression Screening Patterns, Predictors, and Trends Among Adults Without a Depression Diagnosis in Ambulatory Settings in the United States https://pubmed.ncbi.nlm.nih.gov/29983110/ Primary versus Specialty Care Outcomes for Depressed Outpatients Managed With Measurement-Based Care: Results From STAR*D https://pubmed.ncbi.nlm.nih.gov/18247097/ The PHQ-9: Validity of a Brief Depression Severity Measure https://pubmed.ncbi.nlm.nih.gov/11556941/ VitalSign6: A Primary Care First (PCP-First) Model for Universal Screening and Measurement-Based Care for Depression https://pubmed.ncbi.nlm.nih.gov/31091770/ A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7 https://pubmed.ncbi.nlm.nih.gov/16717171/ Prevalence and Impact of Diagnosed and Undiagnosed Depression in the United States https://pubmed.ncbi.nlm.nih.gov/36134073/ FDA Approves First Treatment for Post-partum Depression https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-post-partum-depression

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/

Recognizing and ManagingPediatric Suicidality   Evaluation and Credit:  https://www.surveymonkey.com/r/MedChat49   Target Audience             This activity is targeted toward primary care and pediatric healthcare providers and advanced providers.   Statement of Need  Suicide is a major public health concern and the second leading cause of death for adolescents. Research suggests that many patients that commit suicide had seen a health care provider within two months preceding the event; yet, research also indicates that pediatricians may not feel adequately trained to manage behavioral health complaints, including suicidality. These factors reinforce the need for practitioners to screen patients for imminent suicidal risk. However, even if a screening assessment is utilized routinely, providers may not be fully comfortable managing a patient presenting an identified risk.  (Adolescent suicide: what can pediatricians do? Current Opinion; 2020)   Objectives  1.  At the conclusion of this offering, the participant will be able to:  2.  Describe the risk factors for suicidal idealization in the pediatric population.Discuss effective screening tools and implementation recommendations for suicidality. 3.  List components of the patient safety plan for the at-risk patient.   Moderator Erin Frazier, M.D. Pediatrician Norton Children's Medical Group Norton Healthcare Louisville, Kentucky   Speakers Katy Hopkins, M.D. Pediatric Psychologist Norton Children's Behavioral Health – Hikes Point Norton Healthcare Louisville, Kentucky   Moderator, Speaker and Planner Disclosures   The planners, speaker and moderator of this activity do not have any relevant relationships to disclose.    Commercial Support   There was no commercial support for this activity.    The National Suicide and crisis Hotline number is 988, and is available 24 hours a day, 7 days a week.   Physician Credits   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 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.   Nursing Credits Norton Healthcare Institute for Education and Development is approved with distinction as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation (ANCC). This continuing professional development activity has been approved for 1.0 contact hours. In order for nursing participants to obtain credits, they must claim attendance by attesting to the number of hours in attendance.    For more information related to nursing credits, contact Sally Sturgeon, DNP, RN, SANE-A, AFN-BC at (502) 446-5889 or sally.sturgeon@nortonhealthcare.org.   Resources for Additional Study: National Institute for Mental Health – Ask Suicide-Screening Questions (ASQ) Toolkit https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials   American Psychological Association – Patient Health Questionnaire – 9 (PHQ-9) https://www.apa.org/depression-guideline/patient-health-questionnaire.pdf   Assessment and Management of Depression and Suicidality: Pediatric Resident Perspectives on Training and Practice https://pubmed.ncbi.nlm.nih.gov/32525351/   Pediatric Suicide Screening: A Review of the Evidence https://pubmed.ncbi.nlm.nih.gov/33387798/     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 |February 2023; Information is current as of the time of recording.  Course Termination Date | February 2025 Contact Information | Center for Continuing Medical, Provider and Nursing Education; (502) 446-5955 or cme@nortonhealthcare.org    

Happy New Year from The Health Feast! After a regular mind-body-soul/spirit check-in with Dr. Rak and Po, they first take an opportunity to thank their growing audience and reflect a little more on why they started The Health Feast.  Then they get into today's topic of New Year's Resolutions.  Dr. Rak reviews some of the stats around resolutions and how most are unsuccessful.  The two discuss why this is and how the best resolutions are process-oriented instead of outcome-oriented. The two also reflect on the importance of grounding your resolutions and goals in your WHY and intention, and Dr. Rak reflects on some of the reasons for wanting to make change that he hears from patients. Dr. Rak helps Po think about his behaviors in terms of ideals (what I'd ideally like to do most days) and standards (what I do every day regardless of how I'm feeling and what else is going on). They also discuss Po's recent feelings of lower mood.  Dr. Rak screens Po for depression using a standard survey called the PHQ-9.  You can access this inventory at https://www.mdcalc.com/calc/1725/phq9-patient-health-questionnaire9.  The two reflect on the role of mental health in our overall health and how it affects our ability to change our habits. The show ends with Po reflecting on his prior goal to incorporate regular meditation and how he wants to approach the coming week.  Have a question or comment for Dr. Rak and Po?  You can submit them on our website at thehealthfeast.com  Disclaimer: The Health Feast is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. If you or someone you know is experiencing depression or any mental health concerns, please seek out care from a licensed professional.  The opinions expressed are our own and do not necessarily reflect the opinions of our employers.

Depresyon hakkında bazı bilgiler ve sizden gelen 6 farklı hikaye.(Hikayelerini gönderen, yorum yazan herkese ve tüm Patreon destekçilerine teşekkürler).Bölümler:(00:05) Eğlenceli konular: Depresyon ve anskiyete.(01:10) Mutluluk için tasarlanmadık.(03:05) Kordoba Emirinin 14 mutlu günü.(04:15) Depresyonun farkı.(04:55) PHQ-9 testi.(06:05) Alper'in hikayesi.(07:45) EM'in hikayesi.(09:55) A'nın hikayesi.(10:20) Kitap: Adult Children of Emotionally Immature Parents.(11:05) Kitap: This Is Your Brain on Food.(11:35) T'nin hikayesi.(13:35) Kitap: Hayatı Yeniden Keşfedin.(14:37) F'nin hikayesi.(18:05) M'nin hikayesi.(28:25) Patreon Teşekkürleri..Kaynaklar:Yazı: Humans aren't designed to be happy – so stop tryingDepresyon Testi: PHQ-9 (Türkçe)Makale: Can Dancing Relieve Depression Symptoms?Makale: How Journaling Helps Manage DepressionVideo: Why Depression is Different per GenerationYazı: Serotonin Nedir?Kitap: Adult Children of Emotionally Immature Parents.Kitap: This Is Your Brain on Food.Kitap: Hayatı Yeniden Keşfedin.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: StrongMinds should not be a top-rated charity (yet), published by Simon M on December 27, 2022 on The Effective Altruism Forum. GWWC lists StrongMinds as a “top-rated” charity. Their reason for doing so is because Founders Pledge has determined they are cost-effective in their report into mental health. I could say here, “and that report was written in 2019 - either they should update the report or remove the top rating” and we could all go home. In fact, most of what I'm about to say does consist of “the data really isn't that clear yet”. I think the strongest statement I can make (which I doubt StrongMinds would disagree with) is: “StrongMinds have made limited effort to be quantitative in their self-evaluation, haven't continued monitoring impact after intervention, haven't done the research they once claimed they would. They have not been vetted sufficiently to be considered a top charity, and only one independent group has done the work to look into them.” My key issues are: Survey data is notoriously noisy and the data here seems to be especially so There are reasons to be especially doubtful about the accuracy of the survey data (StrongMinds have twice updated their level of uncertainty in their numbers due to SDB) One of the main models is (to my eyes) off by a factor of ~2 based on an unrealistic assumption about depression (medium confidence) StrongMinds haven't continued to publish new data since their trials very early on StrongMinds seem to be somewhat deceptive about how they market themselves as “effective” (and EA are playing into that by holding them in such high esteem without scrutiny) What's going on with the PHQ-9 scores? In their last four quarterly reports, StrongMinds have reported PHQ-9 reductions of: -13, -13, -13, -13. In their Phase II report, raw scores dropped by a similar amount: However, their Phase II analysis reports (emphasis theirs): As evidenced in Table 5, members in the treatment intervention group, on average, had a 4.5 point reduction in their total PHQ-9 Raw Score over the intervention period, as compared to the control populations. Further, there is also a significant visit effect when controlling for group membership. The PHQ-9 Raw Score decreased on average by 0.86 points for a participant for every two groups she attended. Both of these findings are statistically significant. Founders Pledge's cost-effectivenes model uses the 4.5 reduction number in their model. (And further reduces this for reasons we'll get into later). Based on Phase I and II surveys, it seems to me that a much more cost-effective intervention would be to go around surveying people. I'm not exactly sure what's going on with the Phase I / Phase II data, but the best I can tell is in Phase I we had a ~7.5 vs ~5.1 PHQ-9 reduction from “being surveyed” vs “being part of the group” and in Phase II we had ~5.1 vs ~4.5 PHQ-9 reduction from “being surveyed” vs “being part of the group”. For what it's worth, I don't believe this is likely the case, I think it's just a strong sign that the survey mechanism being used is inadequate to determine what is going on. There are a number of potential reasons we might expect to see such large improvements in the mental health of the control group (as well as the treatment group). Mean-reversion - StrongMinds happens to sample people at a low ebb and so the progression of time leads their mental health to improve of its own accord “People in targeted communities often incorrectly believe that StrongMinds will provide them with cash or material goods and may therefore provide misleading responses when being diagnosed.” Potential participants fake their initial scores in order to get into the program (either because they (mistakenly) think there is some material benefit to being in the program or because they think it makes...

Kim Witczak is a leading global drug safety advocate and speaker with over 25 years professional experience in advocacy, advertising and marketing communications. She is currently a very vocal Consumer Representative on the FDA Advisory committee evaluating new drugs coming to market. Kim Witczak

TRIGGER WARNING: Please note that this episode contains a discussion of suicide, self-injurious behavior, depression and/or reference of other mental health disorders that may act as triggers.    A national project called Zero Suicide aims to address the issue of suicide in the medical and mental health systems. The effort is founded on the idea that suicide can be stopped and that systems of medical and mental health care can do more to do so. Seven elements make up the entire Zero Suicide prevention strategy: LEAD, TRAIN, IDENTIFY, ENGAGE, TREAT, TRANSITION and IMPROVE. These elements insure a practical comprehensive approach to suicide care. In this episode, Dr. Gaggino interviews Dr. Julie Goldstein Grumet. Dr. Grumet is a clinical psychologist and public health expert. Dr. Grumet is the director of the Zero Suicide Institute at EDC, Inc. and she developed the Zero Suicide Toolkit to assist health and behavioral care leaders and leadership teams in implementing the seven elements (mentioned above) of the initiative.   Her goal has been to develop the framework, tools, and work schedules required for the Zero Suicide effort to be implemented effectively.     [00:30 - 06:29] Opening Segment Dr. Gaggino introduces us to Dr. Julie Goldstein Grumet Dr. Grumet tells us about her background and how she came into the field Julie recognized that the healthcare system had been left out of the first national strategy for Suicide Prevention. [6:30 - 9:41] How Dr. Grumet came to develop the Toolkit  First launched in 2014 Taking the guesswork out of implementing the recommendations    An organized, concise blueprint that outlines the seven elements [09:42 - 22:07] What makes this program so different?  Evidence based Fidelity  The Core Clinical Components: Screen, Risk Assessment followed up with a safety plan The seven elements: LEAD, TRAIN, IDENTIFY, ENGAGE, TREAT, TRANSITION and IMPROVE The clinical data and being completely “evidence based” is what makes this program work as well as it does. How Zero Suicide is about a culture shift These components bundled with the seven elements will not only keep the patient safe but will also keep the staff safe as well. [22:08 -48:39] Get comfortable having that conversation  Removing lethal means There are online courses you should take (see link below)  “I GOT THIS” ....   [48:40 - 54:26] Closing segment - Takeaways Thank you to Julie for her time today and to the entire ZS team at EDC for offering guidance and support for system change and ZS implementation. Zero Suicide is an aspirational goal and a methodology for suicide prevention.  In 2012, The Action Alliance included ZS as part of the National Strategy to transform healthcare systems.  ZS is a bundle of strategies that include both clinical components and implementation components.  Strap on your seat belt, this is your roadmap to better care. LEAD, TRAIN, IDENTIFY, ENGAGE, TREAT, TRANSITION, IMPROVE.  You can start at any spot though would HIGHLY recommend LEAD then TRAIN!!!   Many of you are already doing IDENTIFY with PHQ screening as we were.  With the new BF guidelines to add suicide screening this is a perfect opportunity to use TRAIN to implement ASQ or CSSR-S screening. Clinical components include screening, risk assessment, safety planning, lethal means safety, care transitions, hand-offs and caring contacts.   Implementation components include training a “competent, caring and confident staff (us too!), continuous quality improvement/data collection, and fidelity to the model. ZS is a culture shift – the system/hospital/practice bears the responsibility to care for patients using evidence-based strategies that work.  These are not home-grown tools - all of the tools/methods are backed by research.  Consider the medical model -asthma, we know

For the last two months we have had a number of insightful conversations on psychiatric medications and harm caused by the overprescription of drugs. A good way to close out those episodes is to reshare one of our very first episodes to simply answer the question, “Do antidepressants even work?” Originally published in July of 2021.------------When a product is launched in a particular category we expect it to satisfy an unmet consumer need or perform as intended. Shampoo, caffeinated coffee, or running shoes. If the product doesn't work, it won't sell. How often are we scrutinizing our use of pharmaceuticals? Instead, we rely upon the recommendations of our healthcare providers. What if those drugs don't work? And, what if the established guidelines for standard of care are flawed. On today's podcast Roger, Kelly and Sean discuss the efficacy of antidepressants and the subjective process used by doctors to apply the label of “depressed” on us all. If you are in a crisis or think you have an emergency, call your doctor or 911. If you're considering suicide, call 1-800-273-TALK to speak with a skilled trained counselor.RADICALLY GENUINE PODCASTRadically Genuine Podcast Website Twitter: Roger K. McFillin, Psy.D., ABPPInstagram @radgenpodTikTok @radgenpodRadGenPodcast@gmail.comBackground ReadingAttorney Michael Baum: Antidepressants & Teens Relabeling the Medications We Call Antidepressants Patient Health Questionnaire (PHQ-9 & PHQ-2)

Thanks for listening in today. I'd like to welcome you to this episode of Aphasia Access Conversations Podcast. I'm Katie Strong, Associate Professor in the Department of Communication Sciences and Disorders and Director of the Strong Story Lab at Central Michigan University and serving as today's episode host. Today I'm talking with Dr. Sameer  Ashaie from the Shirley Ryan Ability Lab. Before we get into our conversation, Let me tell you a bit about our guest.        Dr. Ashaie is a Research Scientist in the Think and Speak Lab at the Shirley Ryan AbilityLab and a Research Assistant Professor in the Department of Physical Medicine and Rehabilitation at the Feinberg School of Medicine, Northwestern University.  He earned is PhD in Speech-Language-Hearing Sciences at the Graduate Centre, CUNY.  He is recipient of the 2022 Tavistock Trust for Aphasia Distinguished Scholar Award. Dr. Ashaie was also a recipient of NIDILRR's Switzer Merit Fellowship and NIDILIRR's Advanced Rehabilitation Research and Training post-doctoral fellowship. His lab the Shirley Ryan Affective and Emotion Rehabilitation Lab (SAfER) focuses on aphasia rehabilitation, particularly identifying post-stroke depression and related psychosocial disorders. He employs a variety of techniques in his research including eye-tracking and heart-rate variability.   In this episode you will:  Learn about the value of having researchers integrated into clinical care. Be empowered to think about depression on a continuum and why how we measure depression matters. Hear how network models can be a more useful way to examine complex disorders.    KS: Sameer welcome and thank you for joining me today. I'm really excited about this conversation with you, and having our listeners get to know you and your work .  SA: Thank you for having me here. You know I listen to the podcast, and I wasn't expecting to be here one day. So, it's a privilege being here. I KS: Congratulations on receiving the Tavistock Distinguished Scholar Award. Can you tell us a bit about the impact of receiving this recognition?  SA: It's a big honor. You know, oftentimes as an early career researcher in the field of physiology or I guess any field me especially I'm wondering like, if I'm doing whatever I'm doing, is it making sense? Is it making a difference? Are people noticing it? So getting this award especially and people that have gotten before me and the work they're doing? It really validates what I'm trying to do as an indication of where I'm trying to take my research program and I'm hoping that it has an impact on people with aphasia, and as well as the broader research community. KS: Absolutely! I'm excited to start talking about your research. But before we get to that, I'd love to hear a little bit about how you came into the field of speech language pathology, because it wasn't a direct line. Your story is in fact quite interesting. And I think you refer to it as a winding path. Could you tell us a little bit about how you came to be working in the area of aphasia? SA: I started my PhD in theoretical linguistics, looking at generative phonology. And then I ended up taking a class with Dr. Loraine Obler. It was a class on the historical debates on language localization. And that really got me interested in language. After two years in theoretical linguistics, I switched tracks to neuro linguistics, communication science disorders. Because I really got interested in just language, more than just a theoretical perspective that I had as a linguist. And then, of course, there are two people that really had an impact on my career and continue to have an impact on my career. One is that I did my PhD with Dr. Jamie Reilley at Temple. And that's how I got interested into sort of the semantic aspects of aphasia. And he was really supportive and was really great in how we think about science and how we do science.  And then I would say that the person who's had the most impact and continues to have the most impact, and really has made me think about this field is Dr. Leora Cherney. And I'm really indebted to her in terms of how I think about this field, how I think about our participants, how I think about how aphasia impacts their life in totality. And just seeing that kind of dedication and thinking about research that is support to impact people's life. And getting that inspiration from Leora. She has been really critical for me to really falling in love with this field, because you're keeping your participants at the center of the work you do. I mean, you might not see the impact, but you're trying to keep them that that is what your aim is. And I guess that's how I kind of came to this field, you know, some from sort of theoretical linguistics and interested in semantics and then getting a postdoc with Leora. And being inspired by her and the support she's given me to explore things. And carry a different line of research, but always keeping the participants in mind. KS: So, you're a research scientist who works in a rehabilitation hospital. I'm not sure if our listeners know exactly what you do all day long. Would you walk us through a ‘typical day' – if there is such a thing? What do you do in your lab? Would you talk us through that a bit?  SA: Yeah, I, myself did not know what a research scientist is what I was doing! It was all new to me as well. It's different than a traditional academic position, and especially in a place like, Shirley Ryan AbiityLab, which is a rehab hospital. Especially the model in our rehab hospital is that researchers are integrated into the clinical care. So, what I mean by that is that our labs are situated right where therapies are happening. So even though we're not involved in therapy that's happening with the patients getting the care at that time, we can see different types of therapies. That might be OT (occupational therapists) giving therapy, or speech-language pathologists, physical therapists. So that's that integration. You really get to see patients. You get to see sort of different issues that you might not think about, because we're so discipline focused, right? So, it opens up your mind to all sorts of possibilities, collaborations, issues you might not think about. For example, physical factors are really important for people, but seeing that live and that being worked on, it has a different impact on you. The second thing is that, as a research scientist, you're not teaching classes. Your primary work is centered around research, which, which has its perks, but also that you miss sometimes that interaction, you might have had students in a traditional setting. Not that we don't get students (at Shirley Ryan AbilityLab), we do. But the primary focus is really getting the research program started. And there are no things like semesters, you have the whole year. We work on the hospital schedule. And as an early career (professional), a lot of what you do is dependent on how you get funded and that's how you established your lab. So we so for example, as an early career person, you might not necessarily have a lot of students working for you because we're not in a Communication Sciences Disorders department. So that's sort of different. But the main thing is that it's an academic environment, but it's not a university.  KS: Yeah yeah you're right there in the thick of all of that rehab work. That's fabulous. I had the honor of doing a tour at Shirley Ryan at one of the Aphasia Days before COVID hit and it's just such a beautiful facility. It's just stunning. I love hearing about your path and a little bit about your work life and I've been interested in your research for a while now. I'm so excited to have this conversation. Your work in in mood and depression is something that really is an important area and I was hoping as we get started in this conversation if you could frame for us why this is such an important topic that extends to research and clinical work. SA: This is such an important question. And when I started my post-doc in the field of aphasiology, I was not interested in depression or mood. I was really interested in  semantics. But, you know, talking to the patients being embedded in a clinical environment and talking to family members, everybody talked about the importance of mood, and depression. And what I realized is that everybody's talking about its importance. Everybody gives it a nod. But we're not all assessing it in a systematic manner. But we all recognize its importance, and people need this support. So, I started digging in and seeing in the literature what's going on. I came across this meta-analysis that was published in 2017, I think by Mitchell et al., and they looked at I think around 108 studies of stroke and only five studies with people with aphasia have looked at depression. I was like, that does not sound good. And then, studies that are in the field of aphasiology that look at depression used measures hadn't been validated in our field. So, I was like, we all recognize that this is an important problem and people need the support, but before we can go anywhere, that we need to figure out a way, how we can identify depression in people with aphasia, systematically.  And of course, the big challenge I started thinking about that time is “how do you ask people that have language deficits about their inner feelings? Without sort of prompting them?” You know, we all use scales, those of us who do assess depression, we might modify them. But sometimes those questions are tricky to understand. And if you're modifying them, you might lead a person on to an answer. That's one thing. We can rely on caregiver reports for depression, and they're good. But we also know that those reports can underestimate and overestimate depression. And they're highly impacted by caregivers' mood itself. That was another thing. So, I wondered what can we do that assesses this systematically? And we can also include people with severe aphasia, who we often just exclude from these studies and who might have some of these most issues when it comes to mood or depression. There's some work in neurotypicals, that use a variety of techniques. For example, eye tracking. Research has shown that people who are depressed, tend to look longer at sad faces, or stimuli that denote sad valence. And their response is blunted away from positive stimuli. For example, if people are depressed they might look longer at a sad face and they might also look away from a happy face. There is also work looking at heart rate variability as well which uses certain metrics that you could derive from variability in between your heartbeats might tell us something about depression. This is also true with the dilation of our pupils, or EEG. And of course, none of these measures are perfect. Like we know with anything, we're not getting perfect measurements. But I started thinking that “yes, they might not be perfect, but can I come up with an algorithm or some kind of a composite that takes all these things into account, because if they all point to the same problem, then that problem must be there.” So that's one of the things I'm trying to do right now is combine pupillometry, heart rate variability, and eye tracking to see if we can come up with some kind of a metric that can identify depression. That way, we can move away from language in the sense that we're only using minimal language in terms of directions. We might just show people a happy face, or some emotion that some stimuli that denotes emotion.  The second sort of thing, which is really important is that not thinking of depression as something you either have it or you don't have it. It's on a continuum. It could fluctuate. One day, you could have some symptoms. Another day, you might not have any other symptoms. Or in the same day, it might fluctuate. So, how do we assess that? Related to that is not just relying on some scores. For example, we all just take, like, let's say we take a common scale, like the PHQ-9 (Patient Healthcare Questionnaire-9th Edition) and we might take the scores, and we sum them up and say, “hey, this person they're above a cut off”. But in that kind of approach, we're also missing what these individual symptoms are doing. The person might not endorse every single symptom in that scale. But they might endorse some symptoms. So are we just going to say, “no, they didn't meet a cut off, but they had three symptoms that they were on the scale. For example, ‘I was sad. I was fatigued, I had a loss of appetite.” But everything else wasn't there. Are we just going to negate those symptoms? So how do we take these symptoms into account as well, when we are thinking about depression. Within the broader field of psychopathology, there's a lot of movement thinking about individual symptoms as well. So, I'm just basically taking that and applying it to our field. It's nothing new that I'm coming up with, rather is just really seeing what people in the field of psychopathology are doing, confronting all these problems. And thinking about how this can applied to our field, because they might really have a direct impact on something we're doing when it comes to treatment, right? For example, if we start thinking about individual symptoms and that day a person is fatigued. Well that might directly impacted how they respond to treatment rather than just as a sum score. So that's another angle I'm taking when it comes to this work and depression. KS: That is so important. We all know what matters, but can you help us to know like, how big of an issue is mood depression in aphasia, you know, incidence prevalence or what, you know, do we know anything about that? SA: We do. And if you look at the literature, once again, they're so varied. Some papers might report 70%, some papers might report 30%. But I would say at least, it ranges anywhere from 30 to 70%. But I think a lot of that is also dependent on how we're assessing it. Going back to the scales that we are using and how reliable those scales are. There was a systematic review early on that indicated most of these skills might not even be valid. Are we use a caregiver reports? Are we supplementing that with something? In the general stroke population, we know at least 1/3 of stroke patients have depression. And with aphasia, it's between that 1/3 to 70%. It is most likely much more than that. But I think, to really get at it, we really have to start thinking about the tools we're using. But we know it's an issue because clinicians report it, patients report it, caregivers report it, whatever literature we have, which is not much, those studies report it. In our own study, we looked depression that might not meet the threshold for major depression. And we had around 20%, and those that meet (criteria) for minor depression, those were like, 18% or so. So, it's in that 30-40% range. It's a big issue.  But I think the bigger issue is that we are really missing how many people have it? How many people have the different symptoms? And what we also have is an incidence rate, a snapshot of the incidence rate, right? Like, you know, at six months, at one year, but we really need to start thinking about daily and how sort of depression changes over time. It will not be sort of weekly or yearly, we don't have that much longitudinal work, either. When I talk about daily, I talk about real world as well. I don't know if that answers your question… KS: It does. Yes, absolutely. Yeah, I love that, that it's we have some ranges, they are not probably as accurate as they could be, because we don't have the right tools to assess it, and that they're just a snapshot that we're not really looking at this over time or, as you said that day, that daily basis.  SA: One thing that I want to point out is that, and even with the lack of tools it's good that we are still assessing for depression. I don't want to make it seem like that there's nothing out there. But I think like for all of us, even the tools we're coming up with, we should always be thinking in our own, how can we improve upon whatever we have. And we all get attached to the methods we use. But I think at the back of our head, we should always be like, “can we improve these methods? Can we do something better?” Because ultimately, it's not about us. It's about people, our patients, our participants, family members that we're trying to do these things for. So it's really great that tools do exist, but we have to be candid, that we might not be getting everything out of them. They're a great steppingstone, but we have to constantly go back and build and just keep on taking new developments in the field of psychopathology in the field of measurement science and applied to them so that our field is moving along as well. KS: It's kind of the essence of evidence-based practice, right? We're using the best tools that we have at the moment, but that certainly we need to be on the lookout for what's coming in the newer literature or tools. Sameer, you have some really cool projects going on related to depression and mood. You talked a little bit about them earlier, but could you give us a little more detail on what you've got going on?  SA: So, one thing I could kind of hone in on that I mentioned earlier is on eye tracking. Right now we're trying to come up with some kind of an algorithm where we are relying minimally on language. So just the directions are language based. We're getting people in, and we're doing a combination of eye tracking changes in the pupil dilation and heart rate variability, as people are looking at different stimuli that denote different emotions. We have a paper out that looks at the feasibility of it. And what we're basically looking at trying to quantify that using some existing scales and caregiver reports. Can we then take these metrics and see whether people are looking at sad or happy faces, or any other stimuli that denote emotions, and is that related to these traditional scales. And then how can we then come up with a metric based on these three measures, pupillometry, heart rate, and some of the eye tracking indices that can point out depression in people with aphasia? We're using these tools, but the approach is out there. Anytime people are validating new tools, they have to rely on existing tools and go through these different iterations. So right now, we're in the first iteration trying to see what kind of metrics we can extract and what those metrics can give us that are easy to use. And one thing is that eye tracking or heart rate variability over the years, they have become really accessible, and the tools are not expensive themselves. So, with the aim that down the line, can this be used in the clinical setting? Of course, we're far away from that. But that's the end goal, we hope as a quick diagnostic check. KS: Okay, yeah, that's what I was going to ask you, because we've got a lot of listeners who are clinicians. And, you know, sometimes as clinicians, it's difficult to see the relevance of things like eye tracking and heart monitoring, when you're reading literature, when you're trying to figure out, “How can I help this person right in front of me?” So, I was hoping you could explain a little bit why those tools to track variables are so important. SA: I think this is a great question. And I think the big thing is that sometimes we just need to demystify these tools. I liked the way you framed it. We really have to think of them as tools. They're tools that were trying to use to assess a problem that might be difficult with the traditional language measure. That's really it. It's not they are better than behavioral measures. It's that because people aphasia have difficulties in language production and comprehension, can we use something else that relies minimally on language? That's really it. It's not some kind of fancy approach. Yes the tools themselves might sound fancy and stuff, but really the aim is it's just a tool that's addressing a certain problem. And with heartrate variability, we can already see because now it's so common, right? All our Fitbit or Apple Watches, they all have it. And even at a basic level, we're starting to think like, “Oh, this is what my activity level refers to.” So, I've started thinking about those kinds of things in a clinical setting. And the same thing with eye tracking. If these tools are sort of readily available, can we train people to use them in a quick way? Because of course, you could do fancy analyses, but you could also look at just quick measures that if the pipelines are in a place that people could just pull it out. Just like when clinicians give a battery of tests, if you ask me, I'm not a clinician, that's really complicated. You're working with a human being you have to change it on the fly. But people get trained on it all the time and can do it. It is the same thing with these tools but if we are successful in coming up with these metrics and these algorithms.. why not? Can clinicians be trained on using these tools in a clinical setting.  KS: It's exciting to be thinking about that identification of depression or mood disorder. We've got lots of work to do on what to do once it's identified, but just the identification is, as you said, that first step. I was curious if you might be able to recommend something to our listeners, you know, as I said, lots of us are clinicians, about what we should know or do right now about supporting mental health and people with aphasia. SA: I think all the clinicians I've talked to everybody recognizes the problem. That's the biggest step first of all. I think then it is really being aware of systematically assessing it. To be clear, I don't want to negate the support part. That's the end goal. But if we're not assessing depression routinely, then we're missing a big chunk. I want to keep stressing that point. I think the one thing clinicians can do is to start assessing people to the best of one's capability. If you're using a scale, then being systematic with that scale. If you're giving it in one iteration, you're giving it one way, on Day One. When you give it again, try to be as close in how you previously administered it so that we we know that you are assessing that same construct.  The second thing is what I've touched on earlier, is that thinking of depression as a continuum and that it fluctuates. It's not enough to just give a screening once, or to assess this person's mood, pretreatment and post treatment. But what about daily? Because if you start looking at daily variability, you might really start thinking, “Oh, no, we're all here. Like the patient he was feeling kind of down today. I don't know if you've put enough effort into it or something along those lines.” Well, low motivation and those kind of things are symptoms of depression. So I'd like to encourage clinicians to start thinking about assessing this daily.  And I think then, once we start sort of assessing it routinely, and making it a part of our work and not thinking of it as separate. That's the key. Not thinking about it like language is here, depression here. Like you know, the work you do, Katie, on narratives or stories, this is all interactive. They're all impacting each other in some sort of a loop.  And then lastly, once we're getting these, and we're routinely assessing people and getting them, then thinking about getting mental health support. And for that, we really have to start thinking about interdisciplinary work. And you could speak to that as well, because I know that you have those projects going on. We can do everything on our own, working with psychologists, referring people…once we can define these basic systems, and then, you know, down the line and training psychologists or psychiatrists and different techniques that they can work with people aphasia. Or clinicians who are up and coming getting some training. And that this is just part of routine care. It's not something we recognize the importance, but then we kind of put it on the back burner.  KS: Yes, right the back burner. Or say, “we don't have the tools, so we don't know what to do but we recognize it's a problem, but we don't do anything about it.” I agree. Sameer, since you brought up the interdisciplinary work and you have developed some relationships in psychology. I feel like you're kind of an exemplar interdisciplinary collaboration. Could you talk about how this collaboration has influenced your work and give our listeners any tips on how to develop such a rich collaboration? SA: All of the work I'm doing in depression and thinking about this is really influenced by people in the department of psychiatry and psychology. Much of my collaboration is with Dr. Stewart Shankman, who is the Chief Psychologist at Northwestern. And being a part of the National Institute of Mental Health (NIMH) thinking about “how do we conceptualize depression?” and things like that. I just reached out to him, because I was interested in his work. I think we have to not be scared that people might not respond if we reach out. I just emailed him, and he was nice enough to respond. And I started attending his lab meetings and presenting our work to the lab and this problem, “how do you assess depression in people that have language deficits. How do we assess their inner feelings when they can't express themselves?” Being embedded in sort of in his work group, I was really exposed to this work. I don't think I would have been exposed to the work that people in that field are doing. For example, debates about how do we think about symptoms? Or how do we integrate these tools? How do we think about different emotions? And then applying it to our field of CSD. And thinking about metrics of depression. My work has really been influenced by how people in that field are grappling and using these issues. One can't do this work in a void. If there are people who are doing this work and that's their field, it only benefits us to form collaborations with them, learn from them, and bring our unique problems to them. So that we could come up with solutions that integrate the best of our knowledge domains. In other words, that team science approach is really the approach I'm taking towards this issue of depression. I think any work we do in the field of psychosocial disorders, mood, anxiety, fatigue, or whatever, I think it's really important that we start working with people who have focused their career on this issue. KS: I so appreciate you sharing that. And even just the simple tip of putting yourself out there to send an email and introduce yourself to someone who's from a different discipline to start that relationship is important. I envision through attending his lab meetings, you're there in his world, learning about things in a way that you wouldn't be, if you weren't a part of what he's got going on. And thinking deeply about how you can apply that to your interests in aphasia. I'm so excited. Our field just needs this innovation and it's exciting to hear about the work you're doing. SA: If I just did all on my own, I would have been just looking at what's in our field, what's in stroke, looking at papers…but you're not embedded in people who are doing this daily. They might not be doing it in our population, but this is what they're doing. And they're grappling with the conceptual issues as well. Tools, measurement, scales, everything. So that's a huge benefit to us because when we think about depression and stuff, yeah, the work has been done, but when you're embedded in that setting, you could take some of the newer things and start applying it as well. Seeing how we can move rapidly. And of course, then the flipside is like, also the collaborators have to be willing to collaborate with you. Dr. Shankman, he's been great. He's been willing and he's been great at mentoring me. I think most people, if you reach out, and you explain what you're trying to do people are willing and you also can contribute to their work, that I think that you know, these relationships will form. KS: Well, that is how cutting-edge work gets done. It's exciting to hear about it. You also have some additional interesting work, particularly in network analysis. Sameer, could you tell us what network analysis is, and why it's important to life with aphasia?   SA: In a nutshell, if we start talking about networks, networks are everywhere, right? Most of us are privy to the notion of social networks. That we're a bunch of friends, we're connected to each other. And a group of friends might cluster together, and then that cluster is connected to someone else. Anything, we take a look at it, if it's complex, it forms a network. Consider airports, highways, how they're interconnected. Certain things are central and more important than others. That's a network. People often give an example a flock of birds.  Birds might have different characteristics. But when they form a flock, it's made up of different parts, but they're all interacting together to form that flock. That's basically what network is. And it's derived from graph theory in mathematics. But at the end of the day, it's about looking at complexity. Anything that's complex, we could think of it as networks. So the work of network analysis, it's a collaboration between me and Dr. Nichol Castro at Buffalo. Both of us are interested in this approach and we decided to tackle this together. Right now we're building a network model of aphasia. One of the reasons, we decided to think about network approach is that going back, you know, we have these these two approaches, and people do integrate them. People do give nod to them, but impairment-based approach an LPAA (Life Participation Approach to Aphasia). And it's not to say that people that focus on impairment don't care about LPAA, or people that embrace LPAA, don't care about impairment. But generally, there is some kind of distinction being made, either implicitly or explicitly. And you might give nod that one thing is more important than other. But me and Nichol, we started thinking rather than thinking, “Okay, rather than thinking about what is important (language, or depression or anxiety) what about coming up, and thinking about all of them interacting in the network. And not assigning a priori importance to either one of them but rather looking at these interactions between multiple factors, and how they might impact each other, so that we're not missing anything, because aphasia is complex. It's not just about language. It's not just about depression. It's not just about supports (social support). It is about everything. So that's where a network model becomes useful. And then from there on building these initial models, then one could start thinking about treatment. That it is possible in a network, that one thing is more important than the other. And that is taking it one step further in an individual, Individual, A versus B, something might be more important in Individual A, like depression, and in Individual B it's communication confidence. We could start by building a big model first. And of course, all these things have steps and eventually come to that and thinking about how can we identify critical, important factors for a person that we could intervene on? But before we could do that, we wanted to build a bigger model at a group level, and start seeing what things are important in this network? And, and not thinking like, “Okay, I'm gonna just call aphasia…and we all are used to saying ‘aphasia is a disorder of language. Blah, blah, blah,' could be also impacted.' But aphasia is a complex disorder, let's see how these all these things interact.” You don't have to assign the importance to A or B. Or say like, “Okay, I'm going to look at attention, maybe that's about language.” Instead, let's see how all of them are impacting each other and are some things more important than others. I think with this kind of approach…all of us have this thinking. We're just trying to come up with a model that addresses this. And eventually, then this kind of model doesn't have to be just limited to outcomes. People could integrate brain, genetics, you could have different layers. And that goes back to your work about interdisciplinary collaboration. When you start thinking about things as a network, that can also extend to the network of people who are doing work in aphasia. That if it's a complex disorder, and people are looking at all these complexities, because not everybody can do everything that we can take the network of future researchers, and then why not integrate and use that network model for the vision and see all these things? That's what we kind of really are trying to get at. KS: The potential is powerful. Wow. Well, you've got a manuscript in the works that's about this complexity of participation poststroke. I really enjoyed reading about the project. But one thing that really struck me in the findings was how positive affect impacted participation. Could you tell us about this and the project?  SA: So this is all pre-existing data. We wanted to establish some sort of causal relationship at Time Point 1. For example at 3 months post discharge, can you predict something at 12 months post discharge? And one the reasons we were interested in positive affect is that we always think about depression, but positive affect is there too, right? And having positive affect could impact people in a positive way. We wanted to look at all these things, put them on the network and see how they're interacting to determine what might be causing or establishing some sort of causality. What was really interesting is that we thought that perhaps social support would predict participation. But it was really positive affect early on, that was predicting many of these things. When you really start thinking about it, it's not that surprising, because if you're feeling positive, and psychology, then you're going to seek out more help. And then you're going to seek out more help, you might participate more in the community. But having that affirmation is critical, because then once again, it goes back to a question mental health support. How can we focus on positive affect, as well, in our treatment? Maybe, if that's kind of integrated with intervention. If people are feeling better, or happier with that sort of, you know, give them some push towards seeking more help? And it's all cyclical, right? And that's what we are seeing, at least in this early work. KS: Oh, it's really interesting. I think clinically we know that in our gut, but is there something we can do to promote that or help support that down the road? This fabulous, fabulous! Well, Sameer, this time has gone by quickly. I've enjoyed the conversation. As we wrap up, do you have any final thoughts you'd like to share with our listeners? SA: Thank you for having me here. And it's a privilege being in this field, especially as somebody who was trained early on as a linguist, and now I'm doing complete something else. And I'm working with clinicians. It's an honor to participate. It's really a privilege. Thank you for having me here. KS: It's fabulous that you're here and doing this important collaborative work. Thanks for spending time with us today. You've given us lots of food for thought. Listeners, check out the show notes and I'll have links to all of the Shirley Ryan AbilityLab details there as well as Sameer's work and some of the other things that we talked about during today's conversation.  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 go to www.aphasiaaccess.org If you have an idea for a future podcast topic email us at info@aphasiaaccess.org. Thanks again for your ongoing support of Aphasia Access.   Websites and Social Media Shirley Ryan Ability Lab  https://www.sralab.org/   Shirley Ryan Think + Speak Lab https://www.sralab.org/research/abilitylabs/think-speak-lab  Shirley Ryan Affective and Emotion Rehabilitation (SAfER) Lab https://www.saferlab.net/   Shirley Ryan Ability Lab on Twitter/Facebook @AbilityLab    Interested in Digging Deeper?  Ashaie, S., & Castro, N. (2021). Exploring the complexity of aphasia with network analysis. Journal of Speech-Language-Hearing Research, 64(10), 3928-3941. https://doi.org/10.1044/2021_JSLHR-21-00157  Ashaie, S. A.,  & Cherney, L. R., (2020). Eye tracking as a tool to identify mood in aphasia: A feasibility study. Neurorehabilitation and Neural Repair, 34(5), 463-471. https://doi.org/10.1177%2F1545968320916160  Ashaie, S. A., Engel, S., & Cherney, L. R. (2022). Test-retest reliability of heart-rate variability metrics in individuals with aphasia. Neuropsychological Rehabilitation, 18, 1-25. https://doi.org/10.1080/09602011.2022.2037438  Ashaie, S. A., Hung, J., Funkhouser, C. J., Shankman, S. A., & Cherney, L. R. (2021). Depression over time in persons with stroke: A network analysis approach. Journal of Affective Disorders Reports. https://doi.org/10.1016/j.jadr.2021.100131  Mitchell, A. J., Sheth, B., Gill, J., Yadegarfar, M., Stubbs, B., Yadegarfar, M., & Meader, N. (2017). Prevalence and predictors of post-stroke mood disorders: A meta-analysis and meta-regression of depression, anxiety and adjustment disorder. General Hospital Psychiatry, 47, 48–60. https://doi.org/10.1016/j.genhosppsych.2017.04.001 

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

Drs Madhukar Trivedi and Bradley Gaynes discuss the benefits of measurement-based care and how best to deliver it for patients with major depressive disorder. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/968559). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Patient Health Questionnaire-9 (PHQ-9) https://reference.medscape.com/calculator/271/patient-health-questionnaire-9-phq-9 Clinical Results for Patients With Major Depressive Disorder in the Texas Medication Algorithm Project https://jamanetwork.com/journals/jamapsychiatry/fullarticle/482026 Depression, IV: STAR*D Treatment Trial for Depression https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.160.2.237#F1 APA Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts https://www.apa.org/depression-guideline/guideline.pdf The Efficacy of Measurement-Based Care for Depressive Disorders: Systematic Review and Meta-analysis of Randomized Controlled Trials https://www.psychiatrist.com/jcp/depression/measurement-based-care-depression/ Final Recommendation Statement – Depression in Adults: Screening https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/depression-in-adults-screening Nonpharmacologic Versus Pharmacologic Treatment of Adult Patients With Major Depressive Disorder: A Clinical Practice Guideline From the American College of Physicians https://www.acpjournals.org/doi/10.7326/M15-2570 The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), Clinician Rating (QIDS-C), and Self-report (QIDS-SR): A Psychometric Evaluation in Patients With Chronic Major Depression https://www.biologicalpsychiatryjournal.com/article/S0006-3223(02)01866-8/fulltext Hamilton Depression Rating Scale (HAM-D or HDRS) https://reference.medscape.com/calculator/146/hamilton-depression-rating-scale-ham-d-or-hdrs Montgomery and Åsberg Depression Rating Scale (MADRS) https://www.apa.org/depression-guideline/montgomery-asberg-scale.pdf

Podcast 285: TEAM-CBT for Chronic Pain. Featuring Derek Reilly-- with the Exciting Findings from a New British Outcome Study Rhonda begins the podcast with two inspiring emails about our recent podcast on “The Unexpected Results of the Latest Beta Test id the Feeling Good App, Part 1 of 2, published on2-28-2022. One is from Vivek Kishore, who used to come to all of my Sunday hikes prior to the pandemic, and Rizwan Syed, from Pakistan, who is an enthusiastic member of my Tuesday training group at Stanford as well as Rhonda's Wednesday training group. Here's what Vivek wrote Dear David and Jeremy, This is so amazing and has the potential to change the world. I am sure millions across the globe will benefit from this app. Can't wait for its launch. Thank you! Vivek Here's what Rizwan wrote: Dear David: Reading your books changed my life completely. I am so much happy and optimistic about life compared to highly critical of myself and others and had been so much bitter. I am sure your team therapy app would be as mind boggling and revolutionary as had been your bibliotherapy. I am no God. Had I been one, I definitely would have chosen you as my prophet to spread my message. Rizwan Today, we interview Derek Reilly, a Cognitive Behavioral Psychotherapist, and Registered Mental Health Nurse with 20 years of clinical practice  specializing in the treatment in chronic pain. He is an Accredited CBT therapist with the British Association for Behavioral and Cognitive Psychotherapies in the United Kingdom, and a TEAM certified Level 3 TEAM-CBT therapist. Derek is also a founding member of the new TEAM-CBT UK group. He has published papers on panic, OCD, and pain. He lives in Darfield, a small village in South Yorkshire, which is a mining area in England. Derek, like a previous guest, Dr. Peter Spurrier, attended a two-day workshop I conducted on TEAM-CBT in the treatment of anxiety disorders in London in 2015. Although I felt quite discouraged during and after the workshop, thinking I'd done a poor job, and since the crowd size was modest at best, a number of those who attended apparently got the message and became excited about TEAM. Derek said that the emphasis on T = Testing and on A = Assessment of Resistance made the biggest impact on him. He explained it like this: David described the four forms of Outcome Resistance and the four forms of Process Resistance. I suddenly realized that resistance was huge in the population I was treating, and that my biggest error had been trying to “help,” which usually just triggered more resistance and yes-butting by my patients, who would complain that no one was helping them with their pain. Dropout rates were high, and I also felt frustrated with the lack of progress I was seeing in my patients. Both Derek and Peter then attended my four-day intensive at the South SF Conference Center in 2017 and got hooked. Derek said: I thought about testing, and where it could be improved, and developed my own Pain Problem Survey (PPS) of the most common kinds of negative thoughts I was seeing in my patients, as well as the negative feelings these thoughts were triggering, like frustration, anger, anxiety, and more. I asked them to rate three emotions on a scale of 0 to 10, as well as their cognitions and behaviors, and tried to figure out what the resistance was all about. I also discovered that the simple step of T = Testing helped greatly with the E = Empathy, because my patients began to feel understood. This was different from the way I'd been trained which was to push this or that technique to “help” with their pain. He said that the concept of “acceptance” is a popular and common buzzword these days among mental health professionals, but there's a huge difference between intellectual “acceptance” and acceptance at the gut level. He liked the fact that TEAM offered specific tools to bring resistance to conscious awareness and to quickly reduce the resistance as well, as the paradoxical techniques that David has developed. Some of the common Negative Thoughts he heard from his patients included: I should bed doing things quicker. I should be responding faster. The doctor should fix me. Why is this happening to me? This is unfair! Many had been feeling demoralized that there was no medical solution, and ashamed of the fact that the could no longer work and do things that had once been automatic, like housework, or picking up and hugging the grandchildren, or going to work and earning money. Their disabilities seem to contradict their personal values, and they felt like they were letting people down. He said: Many of my patients had 10 or even 20 years of suffering and failed treatments, including multiple surgeries in some cases for back pain, for example, and often complained that nobody had been listening to them. That's why the E of TEAM was so important, and I practiced using the Five Secrets of Effective Communication to respond to their complaints. I worked especially hard on Feeling Empathy. Previously, I'd been way to quick to try to “help,” that just turned my patients off. I was helped by the empathy technique David developed called “What's my grade?” I ask my patients, “would you give me an A, a B, or a C or lower so far?” This was crucial. Then, when I went on to the A = Assessment of Resistance, we began to uncover, or discover, what their negative thoughts and feelings showed about them that was positive and awesome. Because I was practicing in an economically deprived area, I, and many of my colleagues, thought this would be a waste of time, and that my patients might not “get it” because it would seem too brainy or intellectual. But it was the opposite, and by the third session, many were already beginning to see things through an entirely different set of eyes. For example, they could see the many positive in their feelings of shame, inadequacy, anxiety, hopelessness, and even anger. So they began to feel proud of their negative thoughts and feelings. It was also helpful to take the “shoulds” out of their negative thoughts and feelings using methods like the Semantic Method and the Double Standard Technique. These approaches proved much more effective in helping people come to terms with loss/change. Derek described his work with a man who'd been struggling with chronic back pain and depression and daily alcohol abuse, who'd had a suicide attempt and felt useless. Derek said: He was open to examining his own role in his problems, and agreed to cut down on his alcohol intake. He found the Positive Reframing to be helpful, and saw that his negative thoughts and feelings were actually an expression of his high standards, and that his frustration was the expression of his determination not to give up. His guilt and shame showed that he had a conscience, and a moral compass, and that he was honest with himself, and that his frustration and depression about being unable to work showed his core values. Then we did the Magic Dial to see how much he wanted to dial down each negative feeling, like guilt, and used a variety of M = Methods to challenge and crush his negative thoughts. Once he pinpointed and challenged his Hidden Should Statements, his feelings of self-acceptance increased dramatically. Then we ended up using the Externalization of Voices to wipe out his negative thoughts. Derek and I discussed the role of negative emotions in patients with chronic pain and other “medical” symptoms, like dizziness, and chronic fatigue. I summarized my experience as a medical student working in Stanford's outpatient medical clinic with Dr. Allen Barbour, and how that approach was similar to the approach that Derek was taking. I summarized my statistical modeling of three data bases that all showed identical results that the correlation between physical pain and emotional distress is not because physical pain causes emotional distress, but because emotional distress causes an amplification in the experience of pain. This is true of physical pain with a clear medical cause, such as arthritis, as well as so-called “psychogenic pain” where no physical cause can be detected. Derek summarized his recent study of 60 chronic pain patients he treated with TEAM, which was a retrospective “clinical audit,” or chart review study. The study indicated a 57% reduction in scores on the PHQ-9 & GAD7 (commonly used depression and anxiety tests). These reductions were significant at the p < .0001 level. The changes  in the scores on the PPS were also significant. This is the first piece of preliminary evidence in the UK to show effective TEAM-CBT can be in the treatment of chronic pain. He is writing up these finds with a colleague, Anne Garland, a Consultant Nurse Psychotherapist, and hopes to publish them soon. He also found that other negative feelings were also comparably reduced, including the “big three:” frustration, guilt, and anxiety. Derek and his colleagues have their own Tuesday training group in England, and I will soon be joining them with Rhonda for a 90 minute Q and A session. If you'd like to learn more about Derek's work, or if you're interested in training, you can contact him at dwr1971@yahoo.co.uk or www.feelinggood.uk.com. Rhonda and I greatly enjoyed the recording and share great enthusiasm for Derek's work spreading the word about TEAM-CBT in England. We hope you enjoyed the podcast as well, and thank you for your support of our efforts! Rhonda, Derek, and David

On today's episode, Rachel and Alex sit down with Dr. Corey Keeton to discuss how to best take care of patients who are depressed and/or have suicidal ideations.  Dr. Corey Keeton is a a board-certified Family Medicine and Psychiatry physician. Dr. Keeton is currently the medical director of the inpatient consultation and liaison psychiatry service at the University of Cincinnati Medical Center and a learning community preceptor. He earned his medical degree at the Joan C. Edwards School of Medicine at Marshall University and completed his residency in both Family Medicine and Psychiatry at the University of Cincinnati College of Medicine. It is our hope that after listening to this episode you'll feel more comfortable addressing depression and suicidal ideation not only in your patients, but also family and friends. Together we can help erase mental health stigmatization and help identify those in need of help.General resources:SIGECAPS (Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor activity, Suicidal ideations)PHQ-9 questionnaire for depression: https://www.mdcalc.com/phq-9-patient-health-questionnaire-9Note from Unscripted Medicine Team: If you are experiencing depression, anxiety, suicidal ideations know that you do not have to go at it alone.  Please reach out to those close to you or use the numbers listed below. Local (Cincinnati) resources:Psychiatry Emergency Services: 513-584-8577Holmes Clinic (on call nights & weekends): 513-584-4457CAPS same day emergent services: 513-556-0648 M-F 8-5pCAPS 24 hour helpline: 513-556-0648 and press 1National resources: National Suicide Prevention Lifeline: 1-800-273-TALK (8255)Crisis text line: text “connect” to 741741

In this episode we talk about the dreaded PHS, application, PHQ...whatever it's called by different agencies. The PHS has been the downfall of many an applicant. We try to help you navigate the most important parts of this crucial part of the process. You're now able to support our podcast! Monthly donations: https://anchor.fm/pdbackgrounds/support One-time donations: https://www.paypal.com/donate?hosted_button_id=VM6AE5B2A6VF2 Go here for background consultation information: https://www.policebackground.net --- Send in a voice message: https://anchor.fm/pdbackgrounds/message Support this podcast: https://anchor.fm/pdbackgrounds/support

When a product is launched in a particular category we expect it to satisfy an unmet consumer need or perform as intended. Shampoo, caffeinated coffee, or running shoes. If the product doesn't work, it won't sell. How often are we scrutinizing our use of pharmaceuticals? Instead, we rely upon the recommendations of our healthcare providers. What if those drugs don't work? And, what if the established guidelines for standard of care are flawed?On today's podcast Roger, Kelly and Sean discuss the efficacy of antidepressants and the subjective process used by doctors to apply the label of “depressed” on us all. Center for Integrated Behavioral Health - https://www.centerforibh.com/Roger K. McFillin, Psy.D., ABPP - https://twitter.com/DrMcFillin_PsyD?s=20Background ReadingAttorney Michael Baum: Antidepressants & Teens Relabeling the Medications We Call Antidepressants Patient Health Questionnaire (PHQ-9 & PHQ-2)

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

FDA 连续批准2个单抗治疗视神经脊髓炎JAMA 服用维生素D3或阿斯匹林均不能降低抑郁症的风险Nature Neuroscience 夜间光照诱导的类抑郁行为在《神经科星期四 Episode 24》中，和大家介绍了抗补体蛋白C5单克隆抗体依库珠单抗（eculizumab），2019年6月被批准用于治疗水通道蛋白阳性的神经脊髓炎谱系障碍。2020年，又有两个新型的单克隆抗体上市用于治疗视神经脊髓炎。简单回顾一下：视神经脊髓炎谱系障碍（Neuromyelitis Optica Spectrum Disorder，NMOSD）是一种复发性自身免疫性炎症性疾病，通常影响视神经和脊髓。至少三分之二的病例水通道蛋白-4抗体（AQP4-IgG）和补体介导的中枢神经系统损伤有关。沙利珠单抗（satralizumab）沙丽珠单抗（satralizumab）是抗IL-6受体的单克隆抗体，当联用免疫抑制剂治疗时，可降低视神经脊髓炎谱系障碍患者复发的风险。2020年8月，沙利珠单抗被FDA批准用于治疗水通道蛋白-4抗体阳性的、视神经脊髓炎患者。《随机双盲对照研究：沙利珠单抗单药治疗视神经脊髓炎的安全性和有效性的3期试验》Lancet Neurology，2020年5月 (1)这项研究评估了沙丽珠单抗单药治疗视神经脊髓炎患者的安全性和有效性。在这个III期、双盲、安慰剂对照、平行组试验中，纳入了水通道蛋白-4抗体阳性或阴性的成年患者，参与者被随机分配（2:1）在第0、2、4周接受沙丽珠单抗120mg皮下注射或安慰剂，此后每4周接受一次注射。同时停止服用免疫抑制剂。共纳入168名参与者，随访期间，30%治疗组患者和50%对照组患者出现复发。两组间严重不良事件和导致停药的不良事件发生率相似。结论：与安慰剂相比，沙丽珠单抗单药治疗降低了视神经脊髓炎的复发率，具有良好的安全性。英必珠单抗（inebilizumab）英必珠单抗是CD19单克隆抗体，本研究旨在研究CD19单抗在降低视神经脊髓炎中的有效性和安全性。2020年6月，FDA已批准英必珠单抗上市，用于治疗视神经脊髓炎。《N-MOmentum研究：英必珠单抗治疗视神经脊髓炎谱系障碍的2/3期试验》Lancet，2019年10月 (2)这是一项多中心、双盲、随机安慰剂对照2/3期研究。参与者被随机分配到300mg 英必珠单抗或安慰剂组，在第1天和第15天接受用药。共招募230名参与者治疗组中12%的患者随访期间复查，安慰剂组39%出现复发（p < 0·0001）。治疗组中72%的患者和安慰剂组73%的患者出现不良反应。结论：与安慰剂相比，英必珠单抗降低了视神经脊髓炎的复发的风险，具有潜在的应用价值。出血性脑卒中出血性脑卒中一般来源于微动脉或小动脉，出血直接进入脑组织，形成局限性血肿。最常见的原因包括：高血压、脑外伤、全身出血倾向、淀粉样脑血管病及血管畸形。不常见的原因包括：肿瘤内出血、动脉瘤破裂及血管炎。《ARUBA研究：未破裂脑动静脉畸形的介入治疗与单独药物治疗的试验的最终随访》Lancet Neurology，2020年7月(3)是一项多国、多中心的随机试验，旨在评估被诊断为未破裂脑动静脉畸形的成年患者中，病变经过评估适合通过介入手术可以根除病变的情况下，介入治疗还是单独药物治疗效果更好。在预先指定的中期分析：显示在预防症状性卒中或死亡方面，单独药物治疗优于药物治疗和介入治疗的联合治疗组，在平均33·3个月的随访中停止了随机化。研究继续随访平均50.4个月后，单纯药物治疗组的死亡或症状性卒中发生率（3.39/每100人年）低于介入治疗的患者（12·32/100人年）。药物治疗组2例，介入治疗组4例死亡。与介入治疗相比，分配到药物治疗的患者的不良事件较少。结论：经过长期的随访，ARUBA显示在预防未破裂的脑动静脉畸形患者的死亡或症状性卒中方面，单纯的医疗管理仍优于介入治疗。《评论：未破裂的脑动静脉畸形的治疗策略》Lancet Neurology，2020年7月 (4)动静脉畸形是青壮年脑出血的主要原因。当它还没有引起癫痫、局灶性神经缺损的时候，有时偶然在影像学检查中被发现，在这些未破裂的病例中，通过介入治疗栓塞或切除动静脉畸形以及相关动脉瘤，可能可以降低颅内出血的长期风险，但是在随机试验中缺乏风险和收益平衡的证据。《随机对照研究：院外氨甲环酸治疗对中重度外伤性脑损伤患者神经功能预后的影响》JAMA，2020年9月 (5)研究的目的是评估中重度外伤性脑损伤2小时内，院外予氨甲环酸治疗对神经学结果的影响。研究纳入年龄≥15岁、Glasgow昏迷评分19mmHg与死亡率相关，而颅内压