Search Results

The nationwide shortage of stimulant medications approved for the treatment of attention-deficit/hyperactivity disorder (ADHD) remains unresolved nearly 1 year after the US Food and Drug Administration (FDA) first announced a shortage of the short-acting stimulant Adderall (amphetamine mixed salts).1 More recently, supply chain issues have expanded to include other central nervous system (CNS) stimulants used in ADHD treatment, including methylphenidate and lisdexamfetamine. At the time of this reporting, both immediate-release and extended-release formulations of these medications are affected by the shortage, and extended-release oral suspension amphetamine is the only ADHD stimulant drug that is not currently in shortage, according to the US Food and Drug Administration’s (FDA’s) Drug Shortages database. The limited availability of these medications has been linked to various factors, including manufacturing delays and below-quota production of amphetamine products that has resulted in a shortage of at least 1 billion doses. In addition, there has been an unprecedented increase in the number of Adderall prescriptions that reportedly exceeds the number of individuals with a formal ADHD diagnosis. The surge in prescription rates for Adderall and its generic has been partly attributed to unlawful telehealth-based prescriptions from direct-to-consumer companies that increased substantially during the early part of the COVID-19 pandemic. This occurred after the US Drug Enforcement Administration (DEA) suspended the requirement for an in-person evaluation before controlled substances could be prescribed. Michael Bloch, MD, MS, associate professor and director and co-founder of the Pediatric Depression Clinic in the Child Study Center at Yale School of Medicine in New Haven, Connecticut, and Ty Schepis, PhD, professor of psychology at Texas State University in San Marcos spoke with about key considerations regarding appropriate prescribing practices for ADHD medications as well as alternate treatment strategies to be considered as the ADHD drug shortage continues. Dr Bloch recently co-authored a paper describing best practices for the online assessment and treatment of ADHD. Dr Schepis has co-authored studies funded by the FDA and the National Institute on Drug Abuse (NIDA) that investigated the nonmedical use of prescription stimulants and the use of illicit stimulants among adolescents taking prescribed ADHD pharmacotherapy. What is the proper process for prescribing of ADHD stimulant medications? Dr Bloch: The proper process for prescribing ADHD stimulant medications involves first doing a thorough evaluation of the patient which would involve personally examining them to verify the diagnosis and doing rating scales of ADHD symptoms . Generally, an ADHD diagnosis requires verification that the symptoms occur in multiple settings such as school, work, home, and during examination. Dr Schepis: Proper prescribing starts with establishing an ADHD diagnosis and ruling out other potential causes for the person’s symptoms. Sometimes, symptoms of conditions like anxiety disorders overlap with those of ADHD, such as increased distractibility and inattention, so other potential diagnoses need to be ruled out. If someone comes in with a preexisting ADHD diagnosis, a clinician may still want to gather information and make their own formal diagnosis, given the risks associated with prescription stimulant misuse and diversion. Once the diagnosis is made, the process of finding the ideal medication dose through careful titration is the next step. This can be a longer process, depending on the individual’s medication response and their experience of side effects. What are some questionable prescribing practices that may occur with stimulant medications for patients with ADHD, and what are some of the risks that may result from improper prescribing? Dr Bloch: The most questionable prescribing practices that I have heard about are prescribers not personally examining patients or doing a thorough examination. I believe that the time and efficiency pressures of the current practice environment, along with economic incentives in diagnosing and treating patients in less time, has exacerbated the situation. Dr Schepis: With increased use of telehealth during the COVID-19 public health emergency, there are legitimate concerns that people were prescribed stimulant medication without undergoing a careful ADHD diagnosis. Individuals who receive stimulant medication without an ADHD diagnosis often do not benefit in the ways that they anticipate or hope, and their risk for side effects lead to greater potential harms than benefits from the medication. With a thorough diagnosis and good communication with the patient, risks from prescribing should be minimal. What adverse events might occur in patients taking stimulant medications for ADHD, and how should those be addressed in clinical practice? Dr Bloch: The most common adverse events with stimulants are poor appetite and insomnia. These symptoms improve when the stimulant medication is out of the patient’s bloodstream. These side effects are also a common reason that individuals misuse these medications so they can lose weight and stay up later, often to study. Typically, the best way to manage the side effects is to make the patient aware of them and then discuss how to manage the side effects when they occur for example, lower the dosage, switch formulations, or take the medication earlier. Immediate-release generic amphetamines have been the most consistently back-ordered ADHD meds. How should clinicians pivot patients who are taking ADHD medications that are currently unavailable? Dr Bloch: I tend to encourage my patients to take longer-acting stimulants regularly, so the shortage has certainly affected my patients less than others. I would encourage prescribers to transition patients who benefit from stimulant medications to transition to longer-acting formulations and take them regularly. Many long-acting forms of amphetamine are available, although many of those have gotten caught up in the shortage as well as prescribers are generally all transitioning to the same alterative medications, and that leads to another shortage. Dr Schepis: Considering a similar amphetamine can be the next step, but transitions from a generic to brand name medication or between different generic amphetamines can lead to restarting the process of titration and dealing with side effects. Switching to a branded amphetamine may not be allowed by insurance or it could be cost-prohibitive, and even then, most generic and branded formulations have subtle differences that can require changes to dosing. What are some alternate treatment options — including nonpharmacologic strategies — that may be used for patients who can’t access prescribed ADHD drugs affected by the ongoing shortage? Dr Bloch: A lack of access to stimulant medications for patients who benefit from them can cause a major worsening of their ADHD symptoms. By far, the most effective intervention is to find a suitable replacement medication. There are nonstimulant medications and nonmedication interventions for ADHD, but generally these interventions take several weeks or months to reach full efficacy, so they really are not great short-term replacement for stimulants. That being said, over the long run they can decrease the need for and needed dosage of stimulant medication. Dr Schepis: There are options that include pharmacologic agents like atomoxetine, clonidine, and guanfacine, but the consensus is that these nonstimulant medications are not as effective as stimulant medications for ADHD. There is a new nonstimulant, viloxazine, but there is not the level of data on it that exists for older nonstimulants. For nonpharmacologic treatments, cognitive-behavioral therapy (CBT) is the best behavioral treatment for ADHD, but the consensus is that it needs to be part of a multi-modal treatment regimen that includes medication — ideally, stimulant medication. While I would strongly recommend CBT be part of treatment, it takes weeks to be effective as the patient builds skills and improves coping techniques — that kind of learning and behavior change takes time. If a stimulant medication is not available or not an option, CBT and a nonstimulant medication is probably the best option, with the strongest evidence for atomoxetine as a nonstimulant pharmacotherapy. This article originally appeared on Neurology Advisor

Key Takeaways Dementia affects over 6 million U.S. adults, with incidence rising due to aging trends, doubling risk every 5 years post-65. ECT shows promise in managing dementia's behavioral symptoms, despite no FDA-approved treatments, with nonrandomized studies indicating symptom improvement. Retrospective analyses suggest ECT may improve neuropsychiatric symptoms without worsening cognitive function, supporting its potential use. Clinical considerations for ECT include consent, comorbidities, and airway management, emphasizing thorough evaluation of patient-specific factors. Dementia is among the most debilitating neurodegenerative disorders related to aging. More than 6 million adults in the United States have dementia, and both the prevalence and the incidence rates of dementia are expected to rise quickly because of aging trends. The risk of dementia doubles every 5 years after the age of 65 years, and this increases to almost 50% in adults 90 years or older. Individuals with dementia often experience both psychological and behavioral symptoms, including depression, agitation, irritability, apathy, hallucinations, and delusions. There are currently no treatments approved by the US Food and Drug Administration (FDA) to manage behavioral and psychological symptoms of dementia. Nonpharmacological behavioral interventions are often recommended, but these can be difficult to implement in a standardized way and require substantial resources. Electroconvulsive therapy (ECT) has been shown to be very effective as a treatment for severe depression (without dementia). Some clinicians have used ECT as a therapy in severe cases to manage behavioral and psychological symptoms of dementia . Here we review the evidence for the use of ECT to manage those symptoms. Randomized Trials For any proposed therapy or intervention, the gold-standard level of evidence comes from randomized, controlled trials. As of October 23, 2023, there were no completed randomized trials of ECT in patients with dementia. A list of clinical trials of ECT use in patients with comorbid depression and dementia is in the Table. An ongoing, multisite trial (NCT03926520) in which patients with dementia are treated with ECT and usual care proposes to enroll 50 patients and aims to be completed in 2024. There have been 2 prospective, nonrandomized (single group) trials of ECT in dementia that have been completed. In one of these studies, patients were enrolled prospectively and were all treated with ECT. This study (NCT01856010) enrolled inpatients with dementia complicated by severe agitation and aggression who did not benefit from either pharmacological or nonpharmacological interventions. Most of these patients (78.3%) exhibited significantly reduced agitation from baseline to discharge as measured by the Cohen-Mansfield Agitation Inventory, a common assessment of agitation in dementia. The neuropsychiatric inventory scores also significantly decreased from baseline to discharge, indicating an improvement in memory (P < .001). Further, the Clinical Global Impressions Scale scores changed from a rating of “markedly agitated/aggressive” at baseline to a rating of “borderline agitated/aggressive” at discharge. There was no change in functioning (daily living) before or after ECT. Five of 23 patients discontinued treatment, with 3 patients stopping due to adverse events (2 for confusion/delirium, 1 for atrial fibrillation) and 2 patients stopping due to poor clinical response. Another study (NCT02969499) recruited 33 individuals with dementia who were treated with ECT. In this study, patients exhibited improvement in neuropsychiatric functioning a week following a course of ECT and an improvement in agitation 8 weeks following ECT. There was no discernible worsening in cognitive functioning or dementia symptoms . Retrospective Analyses Many reports of the use of ECT for comorbid dementia and depression or for behavioral and psychological symptoms of dementia are in the form of a case series. Rao and Lyketsos reviewed the medical records of 31 patients with primary dementia who also experienced depression. Compared with before ECT, these patients had lower depression severity scores (12.3 points on the Montgomery-Åsberg Depression Rating Scale) and an overall improvement on the Folstein Mini-Mental State Examination (1.6 points; P < .02). One of the larger studies on the use of ECT in patients with depression and dementia was conducted using Medicare claims data. In this study, 145 patients who received ECT were matched to a control cohort (N = 415) with respect to age, sex, principal diagnosis, medical comorbidities, and baseline scores of activities of daily living. All patients were hospitalized initially and followed for up to 1 year after discharge. This study found that, among those with dementia who were admitted to the hospital for a psychiatric problem, all patients generally declined in their functional status following discharge. Those patients receiving ECT had more favorable summary scores of activities of daily living compared with the control cohort, although the effects were small. Of note, those receiving ECT did not experience a differential worsening in their cognitive function. This is in line with another recent retrospective study of ECT in 313 patients with baseline mild to moderate cognitive impairment, which showed an improvement in cognitive functioning as measured by the Montreal Cognitive Assessment. This finding concurs with an older report of 44 patients with mild cognitive impairment or dementia who underwent ECT and showed no worsening in cognitive deficits irrespective of preexisting cognitive status . Clinical Considerations Given the lack of effective therapies for the behavioral and psychological symptoms of dementia in those with mild cognitive impairment and the profound burden that these symptoms cause to patients and families, it is reasonable to use ECT in select cases. In each case, a thorough analysis of the potential benefits and risks of therapy needs to be conducted and discussed with consenting parties. A few clinical considerations are worth mentioning. First, the issue of consent is paramount. The laws governing consent for ECT are administered at the state level, which means requirements vary considerably across the United States. A thorough and legal consent process needs to be carried out prior to therapy initiation, including an appeal to judicial authorities where required. Careful consideration must be given to the level of cognitive impairment and how this affects the patient’s ability to consent, as well as to local laws and regulations. Second is the consideration of comorbid medical issues. Individuals with dementia and cognitive impairment are often advanced in age and have many medical comorbidities. For some older individuals of a frail medical status, an acute series schedule of 2 treatments per week (as opposed to 3 times per week) can allow for a more tolerable treatment course. Another consideration involves management of the airway. Sometimes patients with dementia have difficulty managing secretions. The judicious use of an anticholinergic medication (eg, glycopyrrolate) can help improve the safety of airway management during the periprocedural time. Concluding Thoughts Large database analyses of thousands of patients have essentially ruled out the possibility that ECT causes dementia. Further research involving smaller groups of patients with dementia or cognitive impairment has also supported the reassuring conclusion that ECT does not worsen baseline dementia or cognitive impairment. In fact, some data suggest an improvement in cognitive function following ECT. Where resources are available, where patient and family preferences and clinical considerations provide, and when potential benefits outweigh the risks, ECT can be considered in select cases to manage the behavioral and psychological symptoms of dementia. Note: This article originally appeared on Psychiatric Times .

What can be done to restore balance in healthcare delivery KEY POINTS Mental health care tends to bring in less money than other areas of medicine. Private healthcare organizations are increasingly cutting back on delivering mental health care. There are specific steps that can be taken to reverse the outsourcing of mental health care to the public. Outsourcing of Mental Healthcare Who should be delivering healthcare? Private companies? The government? The debate over what works best will go on for years. As it continues, what clearly isn’t working is this strange hybrid situation we current have in which some aspects of healthcare are predominantly within the private world (including “not for profit” organizations that operate very much like private entities) while others are much more likely administered by federal, state, and local governments. Which type of healthcare goes one way or the other is fairly predictable, and is primarily driven by, big shocker, money. Certain areas of healthcare are simply more profitable than others. Surgery, imaging and radiology, cardiac care – these things tend to bring in dollars so it is no surprise that private healthcare providers build lots of capacity and offer plenty of access for these services. Primary care, not so much, but since primary care clinicians are the ones who often refer patients to these more profitable areas they tend to be tolerated and kept close within the organizational structure. What type of care is at the bottom of the heap? That would be mental health, which tends to be time-intensive, less procedure-based, and disproportionately needed by people with fewer financial resources. If times get tough, then, it can be very tempting to drop the less profitable areas of your business while holding on to the more profitable ones, and this is exactly what has been happening when it comes to large private hospitals and clinics and mental health care. And who is expected to pick up the slack for providing critical areas of care that tend to make less money? That would be you - in the form of state or county clinics that are funded and run by taxpayers. This form of public subsidy that permits private healthcare organizations to retain more profitable sectors of medicine while offloading the less profitable ones to the public has been going on for decades in mental health. In many areas around the county, things have now reached crisis levels, as anyone who has recently needed outpatient or inpatient mental health treatment (and who isn’t wealthy enough to pay out of pocket for it) can well attest. Hospital psychiatry units are closing fast, almost as fast as elective surgery centers are opening up. And while these private healthcare organizations may save money in the short-term, the long-term effect may be to convince more and more people that the whole private healthcare thing is fundamentally flawed and needs to be taken over (all of it) by the government. Short of that, however, there are some things that can help bring this system into better balance. Major healthcare providers are typically subject to regulation, often by state government. These regulatory bodies might consider using this power. Sure, big hospital, you can open up that shiny new vascular surgery center, but you have to keep your inpatient psychiatry unit going as well. Insurance providers, starting with federal and state ones like Medicare and Medicaid, could adjust their payment rates to bring mental health care closer to parity with physical health. Just imagine what might happen if a 3-hour autism evaluation (a complicated and potentially life changing assessment) was compensated anywhere near the rate of a 3-hour procedure or medical test. If this happened, I guarantee you that parents would no longer be waiting a year or more to get their child evaluated. We can continue to move away from traditional “fee for service” models, that provide financial incentives to do as many expensive tests and procedures as possible, to models that pay healthcare organizations a fixed amount of money per individual per month. These “capitated” models tilt the financial incentive the other way, rewarding organizations to keep people healthy. Given the research showing that mental health is a foundation for all health, the value of good mental health care, both preventively and for those already struggling, becomes hard to ignore. In summary, the ability of big private healthcare organizations to simply “opt out” of providing critically needed mental healthcare cannot continue and needs to be actively confronted. It is not the responsibility of the public taxpayer to balance the budgets of big corporations through the outsourcing of mental healthcare to publicly run clinics and hospitals. About Dr. Vilash Reddy a child, adolescent, and adult psychiatrist who is a blend of therapy with modern medicines and/or alternative remedies. He also have a holistic approach to each one of my patients, which can be a fusion of medicine and/or therapy and/or alternative supplements/remedies. And he customize and educate you throughout the process.

Key points Outside of its major symptoms—impulsivity, distractibility, hyperactivity—ADHD comes with surprising traits. Rather than waking them up, people with ADHD may find that coffee makes them sleepy. People with ADHD often concentrate better when loud music is playing. Many people with ADHD find that they are calm in times of crisis. Attention-deficit/hyperactivity disorder (ADHD) is primarily known for its inattentive, hyperactive, and impulsive symptoms. However, recent research and lived experience show that this is not the whole story. There are many traits of ADHD that most people don’t know about yet that are also often part of life with this neurotype. If you relate to these, it might be worth looking into ADHD. 1. Coffee makes you sleepy. In neurology, there is a concept called optimal arousal. It is the idea that there is a certain amount of stimulus that helps you move and do things. Not enough stimulation and you’re bored and sleepy; too much stimulation and you’re nervous and overwhelmed. People with ADHD tend to have a higher threshold for optimal arousal because that system works on dopamine. Stimulants, well, stimulate the brain and central nervous system. For some ADHD people at some doses, caffeine stimulates the brain enough that they can sit still, focus on boring tasks, or even fall asleep promptly instead of literally or figuratively pacing. Where most people drink coffee to wake up, because it brings their brains slightly above optimal arousal levels, people with ADHD may instead find that after drinking coffee, they are ready for a nap. 2. You need loud music to concentrate. Something that also helps ADHD brains reach optimal arousal is music. Having loud music when doing homework or while working is a way for ADHD brains to self-regulate and keep the dopamine flowing. One study even showed that adolescents with ADHD see their reading comprehension increase with music, while teens without ADHD struggle to keep up when there isn’t silence. This is also to show that different brains have different needs to keep working optimally. 3. You’re calm in times of crisis. ADHD brains are usually understimulated, hence the hyperactivity and the nervous energy. When a crisis hits, the associated adrenaline may restore your brain to optimal arousal levels—so suddenly, while everyone else is freaking out, you feel calm and composed. These periods of stress are often associated with a decrease in ADHD symptoms , but can be followed by a crash. After a sprint, you will need to rest. So if you find yourself being the only calm person in times of crisis, remaining calm while everyone freaks out, it may mean that your brain is constantly understimulated—which may, in turn, indicate that it’s worth looking into ADHD. 4. You have a low tolerance for noisy spaces. If you have ADHD, you may need loud music to concentrate, but noisy spaces make you nervous and angry. It may seem contradictory, but the key element that differentiates those situations is control. In moments where you use loud music to concentrate, you may not need to use your senses, and thus there’s no conflict between the task at hand and the stimulation received. But loud spaces are a whole other story. People with ADHD often have sensory processing issues, which can make those spaces quickly overwhelming. If someone is talking to you, the conversation will be drowned out by the thousands of stimuli that your brain struggles to filter. This may help explain why many people with ADHD are also diagnosed with auditory processing disorder. If you need people to repeat what they say all the time, and can’t manage to follow a conversation even when you give it your all, it may be a sign of ADHD ! 5. You hyperfocus. ADHD isn’t a lack of attention; it is a lack of regulation. The other side of ADHD is called hyperfocus: a state of such intense concentration that nothing else seems to matter for several hours. You may even forget to drink, eat, or go to the bathroom. These intense focusing periods come when you’re interested in something. You may even spend days hyperfixating on a new hobby, on a new friend, or even on a new food. But when that thing starts feeling repetitive, boring, or like an obligation, you find yourself being unable to come back to it, and look for the next new thing. Hyperfocus can be a powerful tool for people with ADHD; the catch is that you don’t always control when it hits. If you periodically lose yourself in a new hobby or interest, learning everything there is to learn while the rest of the time, you’re unable to keep your attention on something for more than five minutes it may be a sign that you have ADHD . While this article is not a diagnostic tool, if you recognize yourself in some of these traits, it may be worth diving a bit deeper into what ADHD is and if you’re already diagnosed, you may have learned something about yourself. Perhaps your next hyperfixation can be ADHD itself. Note: This article originally appeared on Psychology Today .

Keypoint: ADHD pharmacotherapy does not reduce natural-cause mortality risk in individuals with ADHD. Among individuals with attention-deficit/hyperactivity disorder (ADHD), initiating ADHD medication significantly decreases the risk for all-cause and unnatural-cause mortality, according to study findings published in JAMA. However, ADHD medications do not decrease natural-cause mortality risk. It is widely established that ADHD is associated with physical and psychiatric comorbidities that increase the risk for adverse health outcomes, including premature mortality. However, it is unclear whether ADHD medication is protective or contributes to this mortality risk. To this aim, researchers examined whether the initiation of ADHD medication was associated with a decrease in mortality risk, across mortality types. The researchers used data from multiple Swedish national registers to identify individuals aged 6 to 64 years who received a new ADHD diagnosis between 2007 and 2018 and had not previously been prescribed ADHD medication before their diagnosis. The primary outcome of interest was all-cause and cause-specific mortality during a 2-year follow-up period, confirmed using International Classification of Diseases (ICD) codes and categorized into natural (eg, physical conditions) and unnatural (eg, suicide, accidental poisoning) causes. The researchers identified 148,578 eligible individuals with ADHD (median baseline age=17.4 years; 41.3% women). Within 3 months of their initial ADHD diagnosis, 56.7% (n=84,204) of individuals initiated ADHD medication and 43.3% (n=64,296) did not. Overall, 632 individuals died at the 2-year follow-up and 1402 individuals died during the 5-year follow-up. Unnatural causes accounted for over half of these deaths (66.7%). At the 2-year follow-up, the researchers found individuals who initiated ADHD medication had a significantly lower risk for all-cause mortality (hazard ratio [HR], 0.79; 95% CI, 0.70-0.88) and unnatural-cause mortality (HR, 0.75; 95% CI, 0.66-0.86) relative to individuals who did not receive ADHD pharmacotherapy. However, natural-cause mortality was similar between groups (HR, 0.86; 95% CI, 0.71-1.05), regardless of ADHD medication status. These findings were consistent for children, adolescents, young, adults, and boys/men. However, ADHD medication was only associated with a lower risk for natural-cause mortality among girls/women (HR, 0.64; 95% CI, 0.45-0.90). When stratified by type of unnatural causes of death, ADHD medication initiation was associated with a significantly lower risk for mortality due to accidental poisoning (HR, 0.47; 95% CI, 0.36-0.60). Additionally, when the researchers extended their analyses to a 5-year follow-up, ADHD medication remained statistically significant in reducing the risk for unnatural-cause mortality (HR, 0.89; 95% CI, 0.81-0.97), relative to no ADHD pharmacotherapy. The investigators concluded, “ADHD medication may reduce the risk of unnatural-cause mortality by alleviating the core symptoms of ADHD and its psychiatric comorbidities, leading to improved impulse control and decision-making, ultimately reducing the occurrence of fatal events, in particular among those due to accidental poisoning.” Study limitations include a lack of data on nonpharmacological ADHD treatments and an inability to establish causal effects due to the observational design. Note: This article originally appeared on Psychiatry Advisor

Whatever the cause of it is, mental illness can happen to anyone. Whether you're rich or poor, tall or short, black or white, famous or not, you have just as equal a chance of getting it. If you become aware of it, you'll see it's as common as night and day. You probably have a friend, relative, co-worker, or acquaintance who has depression right now; who is experiencing difficulty from a loss in their life be it a job or loved one. Or it could be that they are having trouble in school, like being bullied which could in fact cause them to contemplate sucide. Or maybe they're all of a sudden experiencing too much stress and feel like they're having some sort of emotional breakdown. Here is a list of famous individuals and cultural creatives who have also lived life with mental illness. Paula Deen Agoraphobia and panic attacks Billy Joel alcohol and depression Craig Ferguson alcoholic Karen Carpenter anorexia nervosa Sandra Dee anorexia nervosa Tracey Gold anorexia nervosa, attention deficit disorder; Richard Simmons anorexia nervosa, bulimia nervosa; Kurt Cobain attention deficit disorder and bipolar depression Michael Phelps attention deficit hyperactivity disorder (ADHD) Doug Flutie, Jr. autism Bill Oddie bipolar disorder DMX bipolar disorder Frank Bruno bipolar disorder James Dean Bradfield bipolar disorder Jane Pauley bipolar disorder Macy Gray bipolar disorder Ozzy Osbourne bipolar disorder Rosemary Clooney bipolar disorder Sinead O’Connor bipolar disorder Tony Slattery bipolar disorder Mel Gibson bipolar disorder Britney Spears bipolar and postnatal depression Stephen Fry bipolar depression Alonzo Spellman bipolar disorder Art Buchwald bipolar disorder Axl Rose bipolar disorder Ben Stiller bipolar disorder Bert Yancey bipolar disorder Bill Lichtenstein bipolar disorder Brian Wilson bipolar disorder Burgess Meredith bipolar disorder Dimitrius Underwood bipolar disorder Francis Ford Coppola bipolar disorder Gaetano Donizetti bipolar disorder J.P. Morgan bipolar disorder Jack Irons bipolar disorder Jean-Claude Van Damme bipolar disorder Jimmy Piersall bipolar disorder John Gibson bipolar disorder John Mulheren bipolar disorder Joshua Logan bipolar disorder Kate Millett bipolar disorder Kristy McNichol bipolar disorder Larry Flynt bipolar disorder Linda Hamilton bipolar disorder Ludwig van Beethoven bipolar disorder Margaret Trudeau Kemper bipolar disorder Murray Pezim bipolar disorder Ned Beatty bipolar disorder Patty Duke bipolar disorder Pierre Péladeau bipolar disorder Robert Boorstin bipolar disorder Robert Campeau bipolar disorder Robert Lowell bipolar disorder Robert Munsch bipolar disorder Spike Milligan bipolar disorder Ted Turner bipolar disorder Alvin Ailey bipolar disorder (aka “manic depression”) Abbie Hoffman bipolar disorder (speculated) Isaac Newton bipolar disorder (suspected) Vivien Leigh bipolar disorder after miscarriage Kitty Dukakis bipolar disorder, alcoholism; substance abuse; Patricia Cornwell bipolar disorder, anorexia nervosa, anorexia bulimia;; Carrie Fisher bipolar disorder, substance abuse; Shecky Greene bipolar disorder, with severe panic attacks Charley Pride bipolar disorder; alcoholism John Daly bipolar disorder; alcoholism, gambling addiction; Jaco Pastorius bipolar disorder; alcoholism; substance abuse Winston Churchill bipolar disorder; dyslexia Frances Lear bipolar disorder;, substance abuse Catherine zeta jones bipolar II Adam Ant (Stuart Goddard) bipolar disorder Doug Ferrari borderline personality disorder Marsha Linehan bpd Adam Rickett bulimia nervosa Barbara Niven bulimia nervosa Herb McCauley bulimia nervosa Jane Fonda bulimia nervosa Ally Sheedy bulimia nervosa; substance abuse Sir Elton John bulimia nervosa; substance abuse, alcoholism; Princess Diana Bulimia nevosa, depression and multiple suicide attempts Paula Abdul bullimia nervosa Alanis Morissette clinical depression Alma Powell clinical depression Anne Sexton clinical depression Ben Vereen clinical depression Benjamin Disraeli clinical depression Billy Joel clinical depression Boris Yeltsin clinical depression Buzz Aldrin clinical depression Carmen Miranda clinical depression Cary Grant clinical depression Charles Schulz clinical depression Charley Pell clinical depression Clara Bow clinical depression Connie Francis clinical depression Damon Wayans clinical depression Darryl Strawberry clinical depression Diane Arbus clinical depression Dick Clark clinical depression Dolly Parton clinical depression Dorothy Day clinical depression Drew Carey clinical depression Dwight Gooden clinical depression Eminem clinical depression Emma Thompson clinical depression Eric Clapton clinical depression Ernest Hemingway clinical depression Eugene O’Neill clinical depression F. Scott Fitzgerald clinical depression Frank Lloyd Wright clinical depression George Eliot (Marian Evans) clinical depression Georgia O’Keeffe clinical depression Harrison Ford clinical depression Hermann Hesse clinical depression Hunter Tylo clinical depression Irving Berlin clinical depression Jack Farrell clinical depression James Forrestal clinical depression James Garner clinical depression Janet Jackson clinical depression Jessica Lange clinical depression Jim Carrey clinical depression Joey Kramer clinical depression Joey Slinger clinical depression John Kenneth Galbraith clinical depression John Quincy Adams clinical depression Jose Canseco clinical depression Jules Feiffer clinical depression Karen Kain clinical depression Kendall Gill clinical depression Larry King clinical depression Lawton Chiles clinical depression Leonard Bernstein clinical depression Leonard Cohen clinical depression Mark Rothko clinical depression Meriwether Lewis clinical depression Mike Wallace clinical depression Morrissey (S.P.) clinical depression Natalie Cole clinical depression Neil Simon clinical depression Norman Mailer clinical depression Pablo Picasso clinical depression Pat Lafontaine clinical depression Patrick Kennedy clinical depression Paul Gascoigne clinical depression Paul Simon clinical depression Pete Harnisch clinical depression Peter Gabriel clinical depression Queen Victoria clinical depression Ray Charles clinical depression Rick Springfield clinical depression Robert McFarlane clinical depression Rod Steiger clinical depression Rodney Dangerfield clinical depression Sarah McLachlan clinical depression Scott Donie clinical depression Sheryl Crow clinical depression Sigmund Freud clinical depression Sir Anthony Hopkins clinical depression Sting (Gordon Sumner) clinical depression Susan Powter clinical depression Sylvia Plath clinical depression Tennessee Williams clinical depression Theodore Dreiser clinical depression Thomas Eagleton clinical depression Tipper Gore clinical depression Tracy Thompson clinical depression Walker Percy clinical depression William Styron clinical depression Yves Saint Laurent clinical depression Calvin Coolidge clinical depression (speculated) Elizabeth Hartman clinical depression (speculated) Tiberius clinical depression (speculated) Vincent Foster clinical depression (speculated) Edgar Allan Poe clinical depression (speculated); alcoholism Richey James clinical depression, anorexia nervosa;;alcoholism Robin Williams clinical depression, learning disability; Marie Osmond clinical depression, post-partum Jack Kerouac clinical depression, substance abuse, severe alcoholism; Tammy Wynette clinical depression, substance abuse; Ann-Margret clinical depression; alcoholism Hart Crane clinical depression; alcoholism Robert Young clinical depression; alcoholism Spencer Tracy clinical depression; alcoholism Drew Barrymore clinical depression; alcoholism, substance abuse; Cole Porter clinical depression; alcoholism; paranoid delusions; obsessive-compulsive disorder (speculated) Winona Ryder clinical depression; anxiety Daniel Johns clinical depression; anxiety disorder;eating disorder James Taylor clinical depression; bipolar disorder Vincent van Gogh clinical depression; bipolar disorder (speculated) Charles Dickens clinical depression; bipolar disorder (suspected) Joan Rivers clinical depression; bulimia nervosa George S. Patton clinical depression; dyslexia Audrey Hepburn clinical depression; eating disorders Leo Tolstoy clinical depression; hypochondriasis; alcoholism; substance abuse Donny Osmond clinical depression; social phobia Jackson Pollock clinical depression; substance abuse Kris Kristopherson clinical depression; substance abuse Judy Garland clinical depression;,substance abuse Kurt Vonnegut clinical depression/bipolar Phil Spector clinical depression/bipolar Richard Dreyfuss clinical depression/bipolar Marilyn Monroe clinical depression/suicide David Bowie crying but not diagnosed but lots of family mental health issues Alastair Campbell depression Ben Moody depression Fiona Phillips depression Graeme Obree depression Hugh Laurie depression Keisha Buchanan depression Kylie Minogue depression Lenny Henry depression Lord Bragg depression Meg Mathews depression Mel C: depression Melinda Messenger depression Neil Lennon depression Robbie Williams depression Ruby Wax depression Russell Grant depression Sarah Lancashire depression Trisha Goddard depression Uma Thurman depression Jack Dee depression Dick Cavett depression – found electro shock therapy helpful Delta Burke depression and compulsive hoarding George Michael depression and fear Patsy Palmer depression and panic attacks Angelina Jolie depression and self harm/OCD Dame Kelly Holmes depression and self harm Mike Tyson depression and severe insecurities and anger Heath Ledger depression, anxiety and sleep depravation Herschel Walker dissociative identity disorder Roseanne dissociative identity disorder (aka “multiple personality disorder”); obsessive-compulsive disorder; clinical depression; agoraphobia Courtney Love drub abuse, clinical depression Sophie Anderton drug addiction and depression Alexander Graham Bell dyslexia Alfred Taubman dyslexia Charles Schwab dyslexia Craig McCaw dyslexia David Boies dyslexia David Murdock dyslexia Edward McVaney dyslexia John Chambers dyslexia Lewis Preston dyslexia Nelson Rockefeller dyslexia Richard Branson dyslexia Thomas Alva Edison dyslexia Tom Cruise dyslexia Walt Disney dyslexia Whoopi Goldberg dyslexia William Hewlett dyslexia Woodrow Wilson dyslexia Albert Einstein dyslexia (speculated) Margaux Hemingway dyslexia; alcoholism; clinical depression (speculated) Justine Bateman eating disorders Amy Heckerling eating disorders; obsessive-compulsive disorder Danny Glover learning disability George Washington learning disability Harry Andersen learning disability Henry Winkler learning disability Caroline Aherne major depressive disorder Margot Kidder manic depression (Bipolar) and paranoia Denise Welch nervous breakdown Howard Stern obsessive-compulsive disorder Howie Mandel obsessive-compulsive disorder Marc Summers obsessive-compulsive disorder Howard Hughes OCD (clinical depression and psychosis both speculated Jessica Alba OCD and eating disorder Shayne Corson panic attacks Nicole Kidman panic attacks on the red carpet Earl Campbell panic disorder Kim Basinger panic disorder Donald Trump possible OCD Gail Porter post natal depression Katie Price/Jordan post natal depression Julie Krone post-traumatic stress disorder; clinical depression Brooke Shields postpartum depression Charles “Buddy” Bolden schizophrenia Charles Faust schizophrenia John Nash schizophrenia Peter Greene schizophrenia Syd Barrett schizophrenia Vaslav Nijinsky schizophrenia John Forbes Nash schizophrenia (paranoid-type) Lionel Aldridge schizophrenia (paranoid-type) Veronica Lake schizophrenia; alcoholism Abraham Lincoln severe clinical depression Charles Darwin severe panic disorder Barbra Streisand social phobia Carly Simon social phobia Ricky Williams social phobia Steve Blass social phobia Steve Sax social phobia John Madden specific phobia (flying) Elton John substance abuse and bulimia Halle Berry suicide attempt Tulisa’s mum Tulisa’s mum had scizoaffective disorder Emily Carr various speculations, neurasthenia; hypochondriasis; clinical depression; conversion disorder; schizophrenia: Related Article: Celebrities - Mental Health & Suicide

One movie that I think was very fascinating is a movie called Happy, which is available on Netflix. It is documentary film directed, written, and co-produced by Academy Award nominated film-make Roko Belic. It discusses principles of happiness, particularly through the perspective of positive psychology, through a series of interviews of people from 14 different countries, with varying cultural, socioeconomic differences. This was created based on Belic's interest in trying to understand the fundamental aspects of happiness, which stem from a article he read "A New Measure of Well Being From Happy Little Kingdom", which indicated that the US was the 23rd happiest country in the world. I am not sure how this ranking was measured. Belic spent several years, meeting hundreds of people, to explore his own curiosity of what factors lead to someone being happy. The film helps deconstruct happiness from an abstract concept to a possible formula based on the principles of human psychology. It was interesting because many of the aspects of happiness that were discussed coincide with concepts that were discussed by Abraham Maslow's hierarchy of needs illustrated below. Maslow's theory suggests that the most basic level of needs must be met before the individual will strongly desire (or focus motivation upon) the secondary or higher level needs. Maslow also coined the term "metamotivation" to describe the motivation of people who go beyond the scope of the basic needs and strive for constant betterment. The movie reflects, that regardless of socioeconomic factors and wealth, a individual was capable of feeling happy if he/she were capable advancing their life according the hierarchy that had been stated by Maslow. I thought this was an interest parallel which was not discussed in the movie, however coincided. I think in many ways I believe that Maslow's hierarchy applies to my life, where I try to focus on my health first and foremost. Source: Vilash Reddy, MD

It can be challenging, frustrating trying to find a psychiatrist that takes your insurance as more psychiatrist are opting out of insurance plans based on drops in the rate of reimbursement and various mental health legislating changes. At One Life Psychiatry , we think its very important to be able to use whatever insurance you have when you feel sick mentally or physically. We have added on approximately 15 new insurance plans to our company with ongoing additions as our contracts our finalized. Here is a list of our in-network plans. If you don't see your insurance plan please contact us at 888-855-0947 to verify if your insurance plan in now in-network, as we are continually adding new contracts. Updated: 11/3/2023 Allwell Ambetter Anthem | Elevance Blue Cross Blue Shield BlueCross and BlueShield Cenpatico Cigna and Evernorth GEHA Home State Health Plan Medicaid Medicare Optum Oscar Health Show Me Healthy Kids TRICARE TriWest UMR UnitedHealthcare UHC | UBH VA Community Care Network (CCN) WellCare We want to make mental health care affordable . If we are out-of-network, we will provide you a super-bill of the charges where you can get 50-70% reimbursement (which you should verify with your insurance company. If you don't have insurance, we have self-pay options (with discounted rates for qualified patients on a sliding scale). If prior arrangements are made, we can create an affordable payment plan. More details on our FAQ page . Interested in setting up at appointment - Click here If you have any questions, please feel free to email us at support@onelifepsychiatry.com

Keynote: Anyone could experience a mental health condition or hospitalization. Inpatient mental health treatment is offered when a person needs a higher level of care. Most stays in psychiatric units are short, between three to seven days. Gaining the most from inpatient care often means keeping an open mind. I remember running my fingers through my blonde, 13-year-old hair as my mother's car approached an intimidating building. Instantly, I wanted to go home. My mother had told me we were going to see a doctor. Something felt off. We walked through a set of large doors and clicked a buzzer. Gesturing to me, my mom said, "I'd like to have her admitted." I had no warning of this beyond a few notes on scratch paper I had found with the hospital name sitting on a desk at home. I think I cried more tears that evening and night than ever in my life. My understanding of psychiatric hospitalization came from soap operas and Batman. I didn't know why I was there or how long I would be there. Yet, I met teens who were not too much unlike me. One roommate showed me how to dry my hair through headbanging. We had access to a gym and time outside. Music therapy, activity therapy, and groups all day long. The food was surprisingly better than the food I had at home. There were some anxiety-provoking pieces. The level of control in the space was wild. Other people decided when I got up, what I could wear, who I could talk to, whether or not I could leave the unit, what I ate, and almost every other aspect of my life for the time. I found the realities of restraint, sedation, and seclusion used in the hospital to be frightening. I watched another teen pulled to the ground and carried to the "quiet room" after trying to run for a door. She emerged from sedation the next day. Today, I still advocate against these practices. Some staff did seem to care, knowing that most of us, though young, had complex lives. I still remember one particular staff member by name who shared about his own life, joked, and gave motivational tidbits. He brightened my days a bit. I learned about my mental health condition and began a journey toward recovery. Though the experience was painful, it sparked compassion. The youth came to the space for a myriad of reasons—self-harm, substance use, depression, psychosis. I became aware of a world of suffering I did not know existed and wished to help. Though I wasn't sure how, I hoped that once my mental health improved, I could find a way to show up for others. In 10 days, I returned to life outside the hospital. I wish I had known about psychiatric hospitals before my turn in one. I think it would have made the experience less frightening. "Mental Institutions and Asylums" Recently, in a debate, former president Donald Trump invoked the words "mental institutions and asylums" as he described where immigrants were coming from. These words accompanied others such as "prisons" and "terrorists"—lumping all into the same category. Are psychiatric hospitals dangerous places full of dangerous people? As a therapist who has worked and interned within inpatient environments at times, as well as a former patient myself, I would say no. People seek inpatient mental health care when coping with a mental health crisis or when temporarily needing more rigorous care for a mental health condition. One person might go to the hospital at the advice of their doctor during a particularly nasty turn of depression during which they have struggled with thoughts of suicide and tasks of daily living. Another person might find themselves hospitalized in an emergency room where they have come due to hearing painful voices or in an altered state. Many people find themselves needing inpatient mental health care at one point or another. Among these individuals are neighbors, friends, mothers, teachers, lawyers, and people from many sectors of our community. Anyone can face a mental health challenge requiring hospitalization. Acute psychiatric hospital stays tend to be short: three to seven days on average, depending on response to treatment and case details. To learn more about psychiatric hospitalization today, I spoke with Brittany Burke, a licensed master social worker and intake clinician. She is an expert on mental health and an individual with lived experience of recovery herself. Together, we defined five things everyone should know about psychiatric hospitalization. 1. There Are No Crazy People The people in psychiatric units are representative of the general population. While inpatient units are secure, it is not due to the outlandish nature of the people inside. Rather, as some individuals come to the hospital due to suicidal crisis, these spaces are designed to prevent anyone from harming themselves. When I asked Brittany to describe the space of an inpatient unit, she replied, "A safe environment." In America, most inpatient units are secured with unique rules compared to the outside, giving a sort of bubble away from the rest of the world to focus on one's mental health above any distractions. 2. Healing Often Takes an Open Mind Most people do not wake up one day and think, "You know what sounds fun? Going to the hospital." Going to a psychiatric hospital often involves a host of new experiences. It can feel somewhat tense, and it may be tempting to withdraw or try to find a way out. Brittany recommends being "open" when approached with opportunities like group therapy. She shares the importance of being "willing to learn coping skills" and communicating openly with staff. Whether someone comes to a hospital for physical or mental health concerns, people go to a hospital to get better. We have to be willing to accept help if we want it. 3. The Low Point of a Hospitalization Can Be a Turning Point Brittany shares that the mental health symptoms leading to hospitalization might leave someone feeling "hopeless," "without purpose," or with a compromised "sense of self." In psychiatric hospitals, there usually are some therapeutic components. Utilizing these therapies and experiences to grow and find meaning in a dark time. 4. If Going to Hospital, Ask What You Can Bring Due to constraints meant for one's safety, some items, like shoelaces and hairspray, are not usually allowed in hospitals. Yet, if you are going to a psychiatric unit or know someone who is, you might be able to bring some comfort items. When I asked Brittany what items she recommends asking about, she said, "Books." Although the days in a psychiatric hospital usually involve group therapy, meals, and recreation activities, there can still be a lot of downtime. Having a book can give some added sense of normalcy. 5. There May Be Other Options While inpatient stays are some of the most intense mental health treatment options, sometimes a person might not need this level of care. In many areas, alternatives such as crisis centers or intensive outpatient may be available to someone needing more help than traditional outpatient care but who is not at a level of distress where they need the supervision of psychiatric hospitalization. Intensive outpatient therapy involves going to a clinic during the day to attend group and individual therapies like Dialectical Behavioral Therapy or Cognitive Behavioral Therapy while still keeping the liberty to go home at night. Crisis centers offer mental health care in a space where someone might stay for a few hours or a few days with 24-hour support, but usually without the medical presence of a hospital. Closing Psychiatric hospitalization is an option for treatment when someone needs a higher level of care than what is possible in an outpatient setting. The security of a psychiatric hospital is meant more to prevent individuals from harming themselves rather than to protect others. Anyone can have a mental health challenge that leads them to require inpatient psychiatric care, and willingness to seek this out in a time of need is a sign of strength. Note: This article originally appeared on Psychiatric Times .

Introduction Patients with intellectual disabilities, can be admitted to an inpatient psychiatric unit from their home environment, on a voluntary basis, but are more likely to be admitted based on the recommendations of the patient’s staff or family, due to acute changes in patient’s pattern of behavior. This collaborative effort, by various members of the patient’s support team, help provide the treatment team, with a global picture of the potential struggles that the patient is dealing with. They also help provide objective information, as the patient, based on the linguistic and cognitive capabilities, may not be able to express their symptoms or may lack insight into their behavior. In addition to medication management, on the inpatient unit, it is very important to help patient acquire skills, which can be used to deal with their underlying mental health needs. Therapy is one important mode of treatment that should be emphasized during hospitalization, by increasing a patient’s level of awareness about their condition and helping empower patients, by mitigate feelings of helplessness through acquiring new coping skills, which can be applied in the future. However, based on limited resources, on the inpatient unit, individual therapy may not be feasible. At alternative option, that can be very beneficial in an inpatient setting, is group therapy. Group therapy is a type of psychotherapy that involves one or more therapists working with several patients at the same time. Groups can be as small as 3-4 patients, however group therapy sessions generally involve 7-10 individuals (Lesczc and Yalom, 2005). The implementation of group therapy, for patients on an inpatient setting, can potentially improve compliance with treatment, by increasing a patient’s level of awareness and insight about their underlying symptoms, and decreasing feelings of emotional isolation. Based on the type of staff available, group therapy can incorporate varying creative activities, including music and art therapy, which will increase participation and provide possible coping skills that a patient can utilize in the future (Montgomery, 2002). The number of staff involved in group therapy, should be based on the level of assistance that patients of the group require, to maximization that level of direct participation. Structure of Group Therapy To help define the structure for group therapy, sessions should be held in a room that is exclusively dedicated to group therapy, to minimize the level of unwarranted environmental distractions. One entrance/exit door is preferred to help facilitator keep track of participants. The best sitting arrangement for group therapy would be in a large circle, where the therapist is sitting among the patients, to limit the therapist being viewed as an authoritative figure or the central focus of therapy (Lesczc and Yalom, 2005). Members of the group should be capable of seeing one another, during the entire session. A structured, daily schedule should be posted in the common patient area at the start of the day, with staff reiterating the various activities throughout the day, to maximize participation. As group therapy is not mandatory on the inpatient unit, if possible, staff could offer words of encouragement or small items of appreciation, to participating patients, which can include additional recreational privileges. This type of positive reinforcement will help increase participation in groups and help patients feel empowered in the process. Patients with intellectual disabilities, based on prior experiences, are often told what to do, by an authority figures in their life, so it is important to help maintain a level of autonomy for patients, on the inpatient unit. Principles of Group Therapy In The Theory and Practice of Group Psychotherapy, Dr. Irvin D. Yalom (2005) , discusses the key therapeutics principles that illustrate the benefit of group therapy for patients. Introduction of Hope – a group will consist of individuals at different stages of the treatment process. The journey for recovery will seem less daunting, if patients are able to witness others that are coping and recovering, allowing those in the beginning in the process to feel more hopeful. Togetherness – being a part of a group, with similar experiences, helps each individual understand and recognize that they are not alone or isolated in dealing with their mental illness. Also, it helps the individual understand they accepted and valuable for whom they are. Empowerment – patients have the ability to help one another by sharing their experiences, by increasing the level of awareness of group members. Safe haven – group therapy can be a safe haven for patients, to allow them to discuss their issues and experiences, in a non-judgmental, neutral environment. Mirroring – patients participating in group therapy, can be capable of mirroring positive behaviors and actions of a therapist, to provide them with more tangible ways to communicate and address underlying issues. Practice – through repetition, patients will be able to practice how to apply their newly acquired techniques, which can alter their behavior in a positive fashion. Through repetition, habitual actions may develop into an underlying mentality that the patient can develop. Interpersonal learning – through reflection, individuals can better understand themselves and their experiences. The knowledge they acquire can allow them understand the meaning of events in their lives. Purification – the act of sharing feelings or experiences in a group environment can be beneficial. An individual can release their suppressed emotions, which reduce his level of pain, guilt, or distress. Suppression of emotions can cause physical and psychological tensions within each individual. Confidence – as group members are capable of sharing their feelings and emotions, it can help individuals increase levels of self-esteem and confidence Tailoring Group Therapy for Patients with Intellectual Disability It may have been thought for years, that patients with Intellectual Disability may not benefit from insight-oriented group therapy, to help address their mental health issues, due to potential cognitive limitation, that hinder therapeutic intervention. However, there is increasing evidence and literature over the past 20 years, to illustrate that such individuals can benefit from therapy, if the therapeutic interventions were designed to better fit these individuals’ needs and capabilities (Razza and Tomasulo, 2005). Psychotherapy for patients with ID, is more effective, if it was focused on the use of active/interactive techniques that stimulate learning than a verbal modality alone (Psychology Today, 2013). According to literature, Interactive Behavior Therapy (IBT), developed by Daniel J. Tomasulo, Ph.D, is the most widely used form for group psychotherapy for individuals with intellectual disability, chronic psychiatric issues, or dual diagnosis (Razza and Tomasulo, 2005). The central focus of IBT, is altering the nature and methods to which therapy in conducted, to meet the needs of individuals with ID, as expressive and/or receptive language can be reduced or limited, for certain individuals (Gardner et al., 1996). Importance of Role Playing Role-playing is used in nearly every phase of human development to teach and model behavior. It is a fundamental concept that is reiterated in IBT, to help enrich the therapeutic experience, which has been coined Psychodrama (Marineau, 1989). Psychodrama is an action oriented therapy and technique, which allows expression of a condition or offer a solution, to a particular situation, through active participation in a collaborative group environment (Marineau, 1989). This collaborative approach conducted in an IBT format, places an emphasis on the interaction of participants in the group, rather than the interaction between the patient and facilitator, as the facilitator should provide guidance on the direction of therapy (Razza and Tomasulo, 2005). Structure of the IBT Model The Interactive-Behavioral Model, which in conducted in a four-stage process, uses 45 minute to 1-hour time slots for therapy sessions. The reduced time demands are beneficial to maximize participation, as patients are more physically/emotional present, limiting levels of exhaustion or inattention (Razza and Tomasulo, 2005). 4 Stages of IBT Stage 1: Orientation Goal of facilitator – to create a stable environment for participants, with cognitive impairment to develop skills needed for successful group participation. Focus on creating an environment where each individual is capable of experiencing their feelings and emotions, without interruption, as patients with ID, are unfortunately accustomed to people not listening to them or talking over them. Facilitator should continue demonstrating skills of actively listening to participants, and redirecting members on the importance of paying attention to one another and maintaining good eye contact (Psychology Today, 2013). Stage 2: Warm-Up & Sharing Goal of Facilitator: inviting members to talk about themselves within the group. It is important that each facilitator pay attention to the interaction of members within the group, to help maximize the therapeutic experience. Each member of the group, should take turns disclosing their experiences relating to the topic discussed. Interaction amongst peers is preferred rather than interaction with the facilitator to maximize group adhesion. It can also be beneficial for the experience be interactive, as one member selects another member to continue share his/her experiences (Psychology Today, 2013). Stage 3: Enactment Goal of Facilitator: help the implement techniques such as role-playing to help drive the therapeutic experience for each patient, through direct or indirect participation. The issues or topics that were discussed during the warm-up/sharing experiences are formulated into characters through the collaborative effort of participants and facilitator (Marineau,1989). One type of role playing technique has been coined, the double, in which one or more group members will voice the feelings and thoughts of another member, who is struggling with a given problem. Various styles of enactment can be used such as mirroring, role reversal, doubling, etc., selected by the therapist. Therapist can also include allow participants to select which type of enactment they wish to do (Psychology Today, 2013). Stage 4: Affirmation Goal of Facilitator: validate and acknowledge the effort of each of the participants, involved in-group. Reflect on important highlights of the session, qualities or characteristics of individuals involved that helped maximize the quality of therapy, acknowledge the level of interaction between individuals, which helped to make the group more cohesive. The period of the session helps individuals to identify components of participation that are applicable to the therapeutic goals of the session and applicability in their own life (Psychology Today, 2013). Benefit of IBT approach The style and techniques used in IBT, are not only beneficial for patients with an intellectual disability, but can be utilized for patients with chronic mental illness, such as schizophrenia, depression, etc., as well those with a dual diagnosis. The therapeutic goal is to increase the overall social competence of such individuals and increase each patient’s insight into their condition (Daniels, 1998). The technique of IBT can be applicable to addressing particular mental health issues, such as anxiety, depression, psychosis, which can help patients to address their underlying pathological issues, through a therapeutic modality (Mental Health Reviews, 2005). General Topics to Discuss with Inpatient Population In addition, to IBT, staff involvement should focus on educating patients on topics that are important for mental and physical well being, including nutrition, sleep hygiene, psychotropic education, and exercise. Education on Proper Nutrition –important to discuss with patients the importance of quality nutrition, what types of food/beverage is beneficial for each patient’s medical health. In addition, it is important to address topics such as proper portioning of meals, monitoring calorie intake, and type and quality of nutritional items. Patients are often misinformed or not educated about the importance of quality nutrition, which can have benefits on mental and physical health, to limit or hinder likelihood of developing conditions such as diabetes, heart disease, etc. Education on Sleep Hygiene – important for patients to understand the importance of structuring their life to allow them to maximize the quality and duration that they sleep, as it can be beneficial for mental health. Therapist should discuss topics such as limiting caffeinated beverages before evening, restricting bedroom activities for sleep/sexual activities (limited stimulating activities such as TV, eating, reading), possibility of incorporating relaxation techniques before sleep to reduce internal tension, educating patients on leaving the bedroom, if unable to maintain sleep, etc. Also, important to focus on establishing a consistent regimen in which patients should limit oversleeping, as this can be a counter-productive process. Education on Sleep Medications – inadequate quality of sleep (nighttime restlessness, inability to fall and/or stay asleep, early morning awakening) can have direct effects on any psychiatric condition, the following day, as the brain is unable to feel rested and calm. Important to address topics related to sleep medications, such as residual sluggishness, grogginess to educate patients on being watchful of over-sedating effects of medications. Also, to educate patients on the ill effects of overmedicating with sleep aids, particularly important for patients who self-administer medications. Also, important to discuss with patients to look out for possible side effects with particular medications, such as parasomnia with Ambien, etc. Psychotropic Education – based on patients’ cognitive capabilities, discussing with patients the importance of continuity of medication use, the type of psychotropic meds, as well as potential side effects or withdrawal symptoms. Also, harmful effects that patients experience should be discussed with their providers. Pictorial diagrams or illustrations can be helpful for all patients, particularly those with reception cognitive impairment. Benefits of Exercise – exercise, particularly aerobic exercises, for at least 30 minutes to 1 hour, daily, can be beneficial outlet to dissipate internal tension, which can exist, regards of the etiology of psychiatric illness. Exercise can have physiological effects on the body, as it can reduce level of stress hormones, including cortisol, as well as stimulating the production of endorphins, which are nature mood elevator, as well as pain reliever (Anderson and Shivakumar, 2013). This concept has been vocalized by athletes, as a ”runner’s high”, in which euphoric feelings are felt, after an extended period of exercise. It is important for staff to screen patients, who would be appropriate to participate in physical activities, to limit the likelihood of injury. If patients had physical limitations, exercises could be altered, to allow varying levels of participation within a group. It would beneficial for patient to be capable of participating in exercise groups 20-30 minutes, hopefully three times a day, according to staff availability. Also, outdoor activity, due to increased level of sunlight would be beneficial for patients to naturally increase their level of Vitamin D. Relaxation Skills – it is important for a therapist to help patients address the physical tension that exist, as this is one among a constellation of symptoms of anxiety. A therapist can incorporate techniques such as progressive muscle relaxation or deep breathing, however the level of communication among staff, should be focused on meets the cognitive abilities of each patient. Simpler terminology or directions regarding the exercises, as well as ongoing reiteration, are beneficial to maximize participation within the group. It is important for facilitator to be aware of patients, who have decreased receptive skills, as they may require more individual attention, to reduce the likelihood of being derailed from the group environment. The patient, to reduce or dampen the physical tension that exists during periods of anxiety, can utilize these newly acquired skills (Anderson and Shivakumar, 2013). Conclusion Group therapy can be an effective mode of therapy, used on an in-patient unit, as it can allow patients to become allies in their journey to understand and overcome their mental health needs. The principles of group therapy, discussed by Dr. Yalom, help emphasis the synergistic effect of group therapy on each patient. Patients with intellectual disabilities, in addition to mental health needs, may need adjustment in the type and delivery of group therapy. Based on the discussed literature, the main focus on group therapy, among patients with intellectual disability, should be focused on therapy activities that are more action oriented. According to Interactive Behavior Therapy, patients with intellectual disability are able to absorb and understand topics, when the activities are tailored around their cognitive and linguistic abilities. The duration of each IBT activity should be shorter in duration in maximize concentration on each topic (Psychology Today, 2013). Therapist should devote additional time to reiterate concepts to patients. It is less important to cover a number of topics, but more important that each topic is well understood by the patients. Also, the structure of therapy should focus on interaction among patients, in which they are capable of using role-playing. Also, the therapist seeks the assistance of each member in the group for guidance on developing resolutions to each scenario. This style of therapy is more tangible and meaningful, as patients are capable of participating, rather be lectured to. Also, it may increase their attention span, as various participants are involved. The mode of IBT, in addition to other general topics, should be incorporated into varying therapeutic modalities for patients, while on the in-patient unit. Patients experiencing various mental health issues can participate in IBT, which can be tailored to discuss psychological issues that stem from such conditions. However, it is important to be mindful about how the patient would act in a group therapy, as the purpose of the event in group participation or collaboration, rather than central focus on one particular patient’s behavior or actions. It is important for staff to screen patients before allowing them to participate; otherwise the process would be counterintuitive or counterproductive. Source: Inpatient group therapeutic interventions for patients with intellectual disabilities; Journal of Intellectual Disabilities 19(1); November 2014. Author: Vilash Reddy, MD .

Post traumatic stress disorder (PTSD) is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event. It is natural to feel afraid during and after a traumatic situation. Fear is a part of the body’s “fight-or-flight” response, which helps us avoid or respond to potential danger. People may experience a range of reactions after trauma, and most people recover from initial symptoms over time. Those who continue to experience problems may be diagnosed with PTSD. Post traumatic stress disorder Who gets PTSD? Anyone can develop PTSD at any age. This includes combat veterans and people who have experienced or witnessed a physical or sexual assault, abuse, an accident, a disaster, or other serious events. People who have PTSD may feel stressed or frightened, even when they are not in danger. Not everyone with PTSD has been through a dangerous event. Sometimes, learning that a friend or family member experienced trauma can cause PTSD. According to the National Center for PTSD , a program of the U.S. Department of Veterans Affairs, about six out of every 100 people will experience PTSD at some point in their lives. Women are more likely to develop PTSD than men. Certain aspects of the traumatic event and some biological factors (such as genes) may make some people more likely to develop PTSD. What are the signs and symptoms of PTSD? Symptoms of PTSD usually begin within 3 months of the traumatic event, but they sometimes emerge later. To meet the criteria for PTSD, a person must have symptoms for longer than 1 month, and the symptoms must be severe enough to interfere with aspects of daily life, such as relationships or work. The symptoms also must be unrelated to medication, substance use, or other illness. The course of the disorder varies. Some people recover within 6 months, while others have symptoms that last for 1 year or longer. People with PTSD often have co-occurring conditions, such as depression, substance use, or one or more anxiety disorders. After a dangerous event, it is natural to have some symptoms. For example, some people may feel detached from the experience, as though they are observing things rather than experiencing them. A mental health professional who has experience helping people with PTSD , such as a psychiatrist, psychologist, or clinical social worker, can determine whether symptoms meet the criteria for PTSD. To be diagnosed with PTSD, an adult must have all of the following for at least 1 month. At least one re-experiencing symptom At least one avoidance symptom At least two arousal and reactivity symptoms At least two cognition and mood symptoms Re-experiencing symptoms include: Experiencing flashbacks—reliving the traumatic event, including physical symptoms such as a racing heart or sweating Having recurring memories or dreams related to the event Having distressing thoughts Experiencing physical signs of stress Thoughts and feelings can trigger these symptoms, as can words, objects, or situations that are reminders of the event. Avoidance symptoms include: Staying away from places, events, or objects that are reminders of the traumatic experience Avoiding thoughts or feelings related to the traumatic event Avoidance symptoms may cause people to change their routines. For example, some people may avoid driving or riding in a car after a serious car accident. Arousal and reactivity symptoms include: Being easily startled Feeling tense, on guard, or on edge Having difficulty concentrating Having difficulty falling asleep or staying asleep Feeling irritable and having angry or aggressive outbursts Engaging in risky, reckless, or destructive behavior Arousal symptoms are often constant. They can lead to feelings of stress and anger and may interfere with parts of daily life, such as sleeping, eating, or concentrating. Cognition and mood symptoms include: Having trouble remembering key features of the traumatic event Having negative thoughts about oneself or the world Having exaggerated feelings of blame directed toward oneself or others Having ongoing negative emotions, such as fear, anger, guilt, or shame Losing interest in enjoyable activities Having feelings of social isolation Having difficulty feeling positive emotions, such as happiness or satisfaction Cognition and mood symptoms can begin or worsen after the traumatic event. They can lead a person to feel detached from friends or family members. If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org . In life-threatening situations, call 911 . How do children and teens react to trauma? Children and teens can have extreme reactions to trauma, but some of their symptoms may not be the same as those seen in adults. In children younger than age 6, these symptoms can include: Wetting the bed after having learned to use the toilet Forgetting how to talk or being unable to talk Acting out the scary event during playtime Being unusually clingy with a parent or other adult Older children and teens usually show symptoms more like those seen in adults. They also may develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They may also have thoughts of revenge. Learn more about how to help children and adolescents cope with disasters and other traumatic events. What are the risk factors for PTSD? Not everyone who lives through a dangerous event develops PTSD—many factors play a part. Some of these factors are present before the trauma; others become important during and after a traumatic event. Risk factors that may increase the likelihood of developing PTSD include: Being exposed to previous traumatic experiences, particularly during childhood Getting hurt or seeing people hurt or killed Feeling horror, helplessness, or extreme fear Having little or no social support after the event Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home Having a personal or family history of mental illness or substance use Resilience factors that may reduce the likelihood of developing PTSD include: Seeking out support from friends, family, or support groups Learning to feel okay with one’s actions in response to a traumatic event Having a coping strategy for getting through and learning from the traumatic event Being prepared and able to respond to upsetting events as they occur, despite feeling fear How is PTSD treated? It is important for anyone with PTSD symptoms to work with a mental health professional who has experience treating PTSD. The main treatments are psychotherapy, medications, or a combination of psychotherapy and medications. A mental health professional can help people find the best treatment plan for their symptoms and needs. Some people with PTSD, such as those in abusive relationships, may be living through ongoing trauma. In these cases, treatment is usually most effective when it addresses both the traumatic situation and the symptoms of PTSD. People who experience traumatic events or who have PTSD also may experience panic disorder, depression, substance use, or suicidal thoughts . Treatment for these conditions can help with recovery after trauma. Research shows that support from family and friends also can be an important part of recovery. What is Psychotherapy: Psychotherapy (sometimes called talk therapy) includes a variety of treatment techniques that mental health professionals use to help people identify and change troubling emotions, thoughts, and behaviors. Psychotherapy can provide support, education, and guidance to people with PTSD and their families. Treatment can take place one on one or in a group and usually lasts 6 to 12 weeks but can last longer. Some types of psychotherapy target PTSD symptoms, while others focus on social, family, or job-related problems. Effective psychotherapies often emphasize a few key components, including learning skills to help identify triggers and manage symptoms. One common type of psychotherapy, called cognitive behavioral therapy , can include exposure therapy and cognitive restructuring: Exposure therapy helps people learn to manage their fear by gradually exposing them, in a safe way, to the trauma they experienced. As part of exposure therapy, people may think or write about the trauma or visit the place where it happened. This therapy can help people with PTSD reduce symptoms that cause them distress. Cognitive restructuring helps people make sense of the traumatic event. Sometimes people remember the event differently from how it happened. They may feel guilt or shame about something that is not their fault. Cognitive restructuring can help people with PTSD think about what happened in a realistic way. Medications The U.S. Food and Drug Administration (FDA) has approved two selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant medication, for the treatment of PTSD. SSRIs may help manage PTSD symptoms such as sadness, worry, anger, and feeling emotionally numb. Health care providers may prescribe SSRIs and other medications along with psychotherapy. Some medications may help treat specific PTSD symptoms, such as sleep problems and nightmares. Source: National Center for PTSD

1-2-3 Magic is the no. 1 selling child discipline program in the country! The 1-2-3 Magic program keeps parents in charge and is proven to be effective, produces results quickly , and is the only parenting program based on the fact that parents talk too much ! This an amazing tool for children with behavioral problems, irritability, poor boundaries. Really helps and coach you on how to be an authoritative parent with positive and negative reinforcement. Kids need disciplining but kind words and external validation. Conditions Helpful: ADHD; ODD; Impulse Control Disorder; etc. Parenting is one of the most important jobs in the world, and it can also be one of life's most enjoyable experiences. Small children are engaging, affectionate, entertaining, curious, full of life, and fun to be around. For many adults, parenting provides profound and unique benefits unequaled by any other area of life. Yet being a mom or a dad can also be unbelievably frustrating. Repeat the Twinkie scene more than a thousand times and you have guaranteed misery. In extreme but all-too-common situations, that misery can become the source of emotional and physical abuse. That's no way for anyone child or adult to live. Children don't come with a How-To-Raise-Me training manual. That's why there is a program like 1-2-3 Magic. The 1-2-3 program is currently being used all over the world by millions of parents (including single and divorced), teachers, grandparents, day care centers, babysitters, summer camp counselors, hospital staff, and other child caretakers, all of whom are working toward the goal of raising happy, healthy children. The 1-2-3 program is also being taught and recommended by thousands of mental health professionals and pediatricians . At parent-teacher conferences, teachers recommend 1-2-3 Magic to the parents of their students (and sometimes parents recommend 1-2-3 Magic for Teachers to the teachers!). Why all the enthusiasm? As one parent put it, "1-2-3 Magic was easy to learn and it gave me results. I went back to enjoying my kids and being the kind of mother I knew I could be." More than twenty-five years after the launch of the program, we're hearing from parents today who say, "My kids were great kids and now they're nice adults. We enjoy being with them." 1-2-3 Magic helps children grow up to be self-disciplined adults who are competent, happy, and able to get along with others. In other words, it helps produce emotionally intelligent people―people who can manage their own feelings as well as understand and respond to the emotions of others. 3 Tips for Tantrums Stop talking – Children see parents' reasons and explanations as sure signs that the parent doesn’t know what he or she is doing. Parents need a plan that focuses on gentle but decisive actions—not words. Check out – When a child whines or melts down after a denied request, the parent has 10 seconds to decide what to do. No talking, for example, no eye contact, increase physical distance as much as possible. Soon the kids will begin to realize that tantrums get them only one thing: Nothing. Be Consistent – Can you apply the same strategies in public? Not only can you, you have to! Attempts at reasoning or distraction in a restaurant or grocery store will bring on a tantrum in no time at all. Source: Tiktok @onelifepsych - I have 20k followers where I discussed diagnosis, helpful tools to understood what you are going through. Check it out. Super helpful I hope.