Psychiatrists Aren’t Psychics

Posted April 5, 2012 by Dr. G
Categories: Anxiety, General Mental Health, Psychosomatic medicine

Tags: , ,

I know the two words sound very similar, but they are most certainly not the same. I recently received a request to see a patient to determine if he could get through a procedure without having a panic attack.

If I could predict the future, I would have won the lottery last week! Sadly, I didn’t.

I suppose I understand that other physicians would like to have psychiatric issues under control so that they can get their work done. That’s why I do what I do. However, psychiatric issues, just like medical issues, can be quite unpredictable. No one gets frustrated when a person has an unexpected bout of asthma, but if someone has a panic attack, the reaction to that is that the person isn’t in control of their behavior. The thing is, although some psychiatric issues certainly stem from voluntary behavioral actions, some presentations are involuntary. Like a panic attack, which is a result of the sympathetic nervous system gone haywire.

Anyway I try not to be rude to those asking for help, but needed to vent a little today. Thanks for reading and hopefully you learned something too!

Jackpot Fever

Posted March 30, 2012 by Dr. G
Categories: Gambling, Psychiatry in the Media

Tags: , , ,

I feel like recently I’ve been bombarded with the news of the $540M jackpot that has risen to record levels. It’s on billboards, the news, my morning radio talk show, and all over the internet. Initially, maybe a week or so ago, I was thinking, who cares, there’s always an ongoing jackpot…but then it started growing larger and larger. My morning talk show hosts were asking callers what they would do if they won the jackpot.

And suddenly, I found myself fantasizing about what I would do if I won. Would I tell anyone at first or have the sense to consult with a financial expert first? Would I quit my job? Would I give large chunks of it to family members? Would I go on a shopping spree? Would I upgrade everything (including car, condo, and most importantly shoes)?

I also, of course, began to wonder what it is that is making everyone so excited about this jackpot, which individuals presumably have extremely teeny-tiny odds of winning? The psychiatrist in me began to think about gambling as an addiction or impulse control disorder, which is easier. It is easy to write off gambling addicts who can’t leave the casino after hours and hours of sitting at the slot machines. But what about the average person, who is getting caught up in lotto fever?

I think there are probably a couple of things that drive people to buy lottery tickets despite the ridiculous odds. This article defines the current odds at 1 in 175,000,000! There’s probably better odds of getting into a plane crash, being attacked by a terrorist, and getting eaten by a shark. So despite the odds, what is turning rational people into thinking they actually have a chance?

Well, the first is probably the fantasy–just like me the other day, buying a ticket allows one to escape reality for a short period. And who doesn’t want to escape reality once in a while? My days are not extremely thrilling as a general rule. I think the other is entertainment. When I watched the Superbowl in February, I was bored to tears until my friend and I made a $10 bet (which I won, thank you very much). All of a sudden I was invested in the winner of a game I normally could care less about. The time passed more quickly, and I was perhaps able to enjoy the social gathering in a different way than usual. Same principle can be applied to the lottery; buying a ticket it makes life a little more entertaining and now there’s something to look forward to when it’s time for the drawing. A little excitement has been created, a small risk has been taken, and there is a sense of anticipation about the possibilities.

Finally, I would say the last factor that comes into play is one that I’ve brought up before–that of cognitive dissonance. Even though logically we know that the odds of winning are very low, we convince ourselves that “it’s only $1, so why not?” For some, however, that daily $1 adds up to a lifetime of disappointment and loss. For others, like me, there’s a momentary flash in my mind of those Jimmy Choo’s I’ve been eyeing. And that’s enough–I plan to purchase a ticket tonight. Wish me luck.

Doctors Don’t Know Anything

Posted March 16, 2012 by Dr. G
Categories: Multiple Sclerosis, Obesity

Tags: , , , ,

My apologies for slacking on writing posts recently…little preoccupied with my own life, but we’ll get to that in another post perhaps. Today, though I wanted to discuss doctor’s lack of knowledge about so much! Recently I saw my neurologist and had a follow-up MRI for the MS symptoms I experienced last year. A year ago, I had an MRI that showed multiple lesions, and a few weeks ago, I was told by my doctor that most of the lesions were gone and there was nothing new! Great news, right? Here is the conversation that my doctor and I had:

Doc: So your MRI looks a lot better…a lot of the lesions are gone…
Me: You sound surprised. Is this what you were expecting in the course of treatment?
Doc: Well, sometimes this happens…
Me: Do you think it’s the medication I’ve been taking?
Doc: Perhaps…
Me: Do you normally see this in MS after starting treatment?
Doc: In some cases…
Me: Can you tell me anything definitive?
Doc: Possibly…

Ok, the last two lines were made up, but you get the idea. My doctor really could not tell me whether I am getting better because of the medication I am taking, the lifestyle changes I’m making, the cinnamon I’m eating, or just the course of the illness. I do understand that MS is an unpredictable illness and often times it is difficult to predict whether symptoms are related to specific findings, as well as response to treatment. In fact although I complain (from a patient standpoint) I also have the perspective of a physician. As a psychiatrist, there are many unknowns about mental health, including its etiology, let alone its treatment. We rely on research studies for evidence-based treatment options, but sometimes there just isn’t any data. We then have to rely on our own or others’ clinical experience to guide us. I often start patients on antidepressants, and the patient improves. Did the patient improved from a placebo effect, the medication, the support and counseling, or even exercise? Hard to say in some cases.

Despite my questions, I am of course happy to be doing better. I feel confident enough that the medication I am taking is helping to some degree, so I will continue to take it. But it’s just a guess.

Keeping It Off

Posted December 30, 2011 by Dr. G
Categories: Addiction, General Mental Health, Obesity, Psychiatry in the Media

Tags: , , , ,

I found this NYT article yesterday about the difficulty of successful weight loss, and finally finished reading it today. I have been interested in this topic recently–the science behind weight loss. Partially I’m interested in this because there is increasing evidence that obesity has underlying biological factors that contribute to its epidemic; i.e. obesity is more like a disease, not a choice. The article is fairly long, but some of the more interesting points I found were the following:

1. There are hormonal changes after weight loss (lower peptide YY and leptin, higher ghrelin) that make it hard to keep the weight off (i.e. someone who used to weigh 150 pounds and now weighs 120 pounds, is different than someone who naturally weighs 120 pounds)

2. Some people have specific genes that make them more predisposed to eat higher calorie foods, and make it harder to lose and keep weight off

3. People who successfully keep weight off are the minority of those who try to lose weight, but they all have specific consistent habits, including tracking their food and exercise, weighing themselves daily, exercising daily, eating breakfast everyday, watching less TV, and not “cheating” on holidays and weekends

4. After weight loss, you are more susceptible to cravings than before (and this is shown on brain MRIs in research, and is some of the evidence behind obesity having similarities to addictions)

5. Knowing some of these things can help to improve ways of losing weight

Now after read this article I feel a bit more informed. It is easy to tell those who are obese to eat less and exercise more. While these tenets are still the core of achieving weight loss, we are starting to learn that not everyone has the ability or the genetics to do this things as effectively or efficiently. That being said, it’s not a reason to give. It may just be that we need to start approaching weight loss for people in a different light, for example slowing it down rather than speeding it up. Another reason to avoid those infomercials late at night!

Good luck and as always feel free to leave comments or feedback!

Obesity Counseling to be Paid for by Medicare

Posted December 1, 2011 by Dr. G
Categories: Obesity

Tags: , ,

Recently I have become interested in the obesity epidemic plaguing our country. I’ve actually been interested in obesity and co-morbid psychiatric illness since residency, but recently my interest has been revived. I read that Medicare is going to be reimbursing health care practitioners for obesity counseling and screening. My initial thought was that this is a positive step in the right direction. But the cynic in me began to wonder–what does obesity counseling exactly consist of? Who will be administering this counseling? Will it be nurses, doctors, nutritionists, or psychologists? What data is available that tells us this will actually work?

Currently, the art of “counseling” is already in danger of becoming an extinct entity, as a result of changing insurance reimbursements, which tend to be better for psychiatrists who prescribe medications rather than psychotherapy. This has influenced the state of psychiatry training programs, which have begun to deemphasize training for therapy, favoring instead a focus on psychopharmacology and biology. This has its pros and cons, as with anything, but has turned psychiatrists partially into pharmacists. I find it unfortunate.

But back to obesity counseling. Usually now, when obese patients see their doctors, they hear a lot of the same information over and over again–that obesity leads to hypertension, diabetes, strokes, heart attacks, shorter life expectancy, and so on. To deal with obesity, patients are told to eat healthier and to start exercising. Well, no kidding! All of this information is now readily available anywhere online and is not news to people. So what makes doctors think that repeating this information will all of a sudden get a patient to lose weight? It doesn’t. Which leads to no change, which in the long run, makes doctors become pessimistic, believing none of their patients will change. So they start treating the diabetes and high blood pressure, ignoring the underlying obesity, and it turns into one big never-ending cycle.

I hope this is not what “obesity counseling” will consist of. I hope that what doctors and other health care practitioners start learning is that motivational interviewing and motivational therapy is the way to get patients to start changing. We have to allow patients to tell us why they want to change, not us tell them why they need to. People only change when they are ready to. We need to start learning how to get patients to get closer to that point. It’s easier said than done.

Group Everything Is Better

Posted November 6, 2011 by Dr. G
Categories: Uncategorized

Hi everyone! Sorry I’ve been MIA for the past few weeks. I have been busy with work, and also busy with taking care of myself. I started back up in the gym, and yesterday ran a 5K with a friend of mine. Training for even 3.1 miles is hard when you haven’t run in a few months! Luckily I had been working out so it wasn’t too bad.

Tonight I wanted to bring up the topic of relying on groups for motivation to do what you want, partially because that’s what I have been doing recently. There is a reason that AA (Alcoholics Anonymous) and Weight Watchers work for people. There is evidence that group programs such as these are some of the most effective ways to stay sober and lose weight (respectively of course!). Working in groups is useful for a number of reasons, including being held accountable by others, feeling responsibility for others’ progress, and seeing other people’s progress as an inspiration for yourself. It is helpful for people to get advice from those who have been in their shoes, in order to overcome the obstacles that come with any journey of self-change.

Lately I have been trying to work with others (such as running with friends) in order to accomplish some of my own goals. Having someone else doing the same thing as me keeps me motivated to keep up my progress, which is not easy when I am by myself.

I would encourage that anyone out there who wants to improve themselves in any way–whether it is recovery from mental illness, beating an addiction such as smoking, or wanting to get in better shape–to consider trying it out with other people. You might be surprised at how much more you can accomplish!

Happy mental health! Next post will be much more timely than this one!

Really Destigmatizing Mental (and Medical) Illness

Posted October 1, 2011 by Dr. G
Categories: Depression, General Mental Health, Multiple Sclerosis

Tags: , , ,

Recently I was asked to speak with a large group of resident physicians after one of their colleagues committed suicide the week prior. It was a hard discussion to have for a couple of reasons, including the fact that I had never done such a thing before. I had, however, gone through the same experience when I was in residency training–a colleague committed suicide when I was in residency as well. It was an event that impacted those that knew him, as well as those that did not. This is sadly a topic that is not discussed much–depression and suicide in physicians. Part of the difficulty in confronting this issue, is of course that doctors have a hard time asking for help for their own mental health. However, doctor’s rates of depression and suicide are higher than the general population–but on the other hand they have lower rates of cardiovascular disease.

One of the things I have personally struggled with during my training in medical school and residency, was dealing with depression. Unfortunately, although I was in a psychiatry residency, talking openly about being depressed was still a no-no. What it will take to destigmatize depression is being able to discuss it openly. So although it is hard, I will start in this forum. I have been depressed in the past. Finally after some time, at the encouragement of a friend years ago, I sought really good help for myself, and now I am a completely different person than I was back then.

I was also diagnosed with multiple sclerosis six months ago. This is another issue I have been struggling with, but in the past couple of months I feel I have been able to get a good handle on it, in particular by managing the things I still have control over. One of the things that I have learned though, is that I have an easier time talking to friends about having MS; I never talked that openly about depression. I was worried what others would think of me, that I would appear weak, and so on. I felt that way despite knowing so much about depression and why it happens, how it’s treated, and how it affects people. It has been a struggle dealing with all my health issues, but I’m so glad I’ve had the determination to do it. That being said, I’ve needed a lot of help along the way, and for that I’m grateful too.

If you think you might be depressed, tell someone. Ask for help. If the situation were reversed, wouldn’t you help the person asking? It’s hard to manage these things alone. Happy mental health everyone!


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