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Newsletter
Volume 7, Issue 8
FEB 2017
Problem drinking in older adults
Older adults suffering
from multiple chronic
health conditions and depression are nearly five
times as likely to be problem drinkers as older
adults with the same conditions and no depression,
according to researchers
at the University of Georgia. Their study is the first
to document the connection between multiple
chronic illnesses, depression and alcohol use in
seniors.
This information could
help health care providers
identify which older adults
are most likely to experience problem drinking
and lead to better preventative care for this
segment of society.
The study, conducted by
researchers from the
UGA School of Social
Work, utilized data from
the National Social Life,
Health and Aging Project,
a nationwide survey of
older adults that is funded
by the National Institutes
of Health. Researchers
looked at more than
1,600 individuals aged 57
to 85 who identified as
active alcohol consumers.
Among problem drinkers,
or individuals who reported a high amount of negative consequences associ-
ated with alcohol use, the
researchers found that
more than half—66 percent—reported having
multiple chronic health
conditions, or MCC, and
28 percent reported having symptoms of depression. The researchers also
found that older adults
who experienced MCC
combined with depression
were those who experienced the highest likelihood of problem drinking.
“These findings suggest
that effective training in
screening and referral for
mental health and alcohol
use issues for health care
providers of older adults
may better serve the approximate 4 million older
adults who currently experience problem drinking in
the U.S.,” said Orion Mowbray, assistant professor at
the UGA School of Social
Work and lead author of
the study.
Previous efforts to prevent
and manage disease in older adults have focused on a
single disease at a time,
said Mowbray. Few physicians consider the combination of multiple chronic
conditions in connection
with depression as a potential sign for increased
alcohol misuse, although
screening and follow-up
counseling for behavioral
problems is known to
help.
“There is sufficient evidence that even brief
interventions delivered in
medical-related settings
can have a positive influence on reducing problem drinking among most
older adults,” said Mowbray. “These interventions can include screening for signs of depression in individuals with
long-term health problems, engaging the individual in a conversation
about the risks of problem drinking, and providing a referral for alcoholrelated treatment.”
The study was published
in the October issue of
the Journal of the American Geriatrics Society, and
was presented at the Society for Social Work and
Research’s annual conference in New Orleans.
University of Georgia. “Problem
Drinking in older adults.” Science
Daily, 12 January 2017.
www.sciencedaily.com/releases
Inside this issue:
CMHA Mental Health First 2
Aid Workshop
Managing Powerful Emo2
tions Group
Treatment-resistant schizo- 3
phrenia-distinct from treatment-responsive schizophrenia?
Pets can help people man- 4
age long-term mental
health conditions
Postpartum depression
seems distinct from other
mood disorders
5
Schedule of Events
6
Psychiatrists’ experienc- 7
es of suicide assessment
385 Princess Street
Kingston, ON
K7L 1B9
613-544-2886
[email protected]
Callers in crisis will be
referred to the crisis line
Kingston & Frontenac
613-544-4229
Lennox & Addington
613-354-7521
2
CMHA—Mental Health First Aid Basic
CMHA Kingston is offering a Mental Health First Aid Training (Basic) course on February 23-24, 2017. Mental health first aid
(MHFA) is the help provided to a person developing a mental health problem or in a mental health crisis. The first aid is given
until appropriate professional treatment is received or until the crisis is resolved. Mental Health First Aid Basic is a 12-hour
course focused on adults interacting with adults in all environments. The course discusses the following mental disorders:
Substance related disorders
Mood related disorders
Anxiety and trauma related disorders
Psychotic disorders
Crisis first aid skills for the following situations are learned: substance overdose, suicidal behaviour, panic attack, acute stress
reaction, and psychotic episode.
To add your name to the list, please call CMHA Kingston at 613-549-7027
Course will be held at: Isabel Turner Library
935 Gardiners Road
Kingston
Cost: $200 +HST/person
Managing Powerful Emotions
A FREE 12-week skills training group
Intended to help you better tolerate
and regulate your emotions
This group is designed to help you:

Identify and label your emotions

Understand the purpose of your emotions

Recognize what activates and intensifies your emotions

Understand the relationship between emotions and behaviour
Participants are expected to attend all 12 sessions and to do the work assigned in order to achieve
maximum effectiveness of the program.
Groups are co-ed and will take place at SAC Kingston, 400 Elliot Ave., Unit 1
Childcare is available upon request
For more information and to register, please contact Theresa Metcalfe at 613-545-0762 ext.
105 or email [email protected]
3
Treatment-resistant schizophrenia...distinct from
treatment-responsive schizophrenia?
Schizophrenia is a highly heterogeneous disorder, and around a third of patients are treatment-resistant. The only
evidence-based treatment for these patients is clozapine, an atypical antipsychotic with relatively weak dopamine
antagonism. It is plausible that varying degrees of response to antipsychotics reflect categorically distinct illness
subtypes, which would have significant implications for research and clinical practice. If these subtypes could be
distinguished at illness onset, this could represent a first step towards personalized medicine in psychiatry. A
study conducted by the Psychosis Studies Department, King’s College, London sought to investigate whether current evidence supports conceptualizing treatment-resistant and treatment-responsive schizophrenia as categorically different subtypes.
A systematic literature search was conducted, using PubMed, EMBASE, Psycinfo, CINAHL and OpenGrey databases, to identify all studies which compared treatment-resistant schizophrenia (defined as either a lack of response to two antipsychotic trials or clozapine prescription) to treatment-responsive schizophrenia (defined as
know response to non-clozapine antipsychotics).
Nineteen studies of moderate quality met inclusion criteria. The most robust
findings indicate that treatment-resistant patients show glutamatergic abnormalities, a lack of dopaminergic abnormalities, and significant decreases in grey matter compared to treatment-responsive patients. Treatment-resistant patients
were also reported to have higher familial loading; however, no individual geneassociation study reported their findings surviving correction for multiple comparisons.
Tentative evidence supports conceptualizing treatment-resistant schizophrenia
as a categorically different illness subtype to treatment-responsive schizophrenia. Research is limited, however, and confirmation will require replication and
controlled studies with large sample sizes and prospective study designs.
Source: BMC Psychiatry “Is treatment-resistant schizophrenia categorically distinct from treatment-responsive schizophrenia? A systematic review” Amy Gillespie, Ruta Samanaite, Jonathan Mill, Alice Egerton, James MacCabe, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London UK.
4
Pets can help people manage long-term mental health conditions
Despite evidence that connecting people to relevant well-being resources brings therapeutic benefit, there is limited understanding, in the context of mental health recovery, of the potential value and contribution of pet ownership to personal
support networks for self-management. A study from the University of Manchester aimed to explore the role of pets in
the support and management activities in the personal networks of people with long-term mental health conditions.
The consistent presence of pets was described as providing a tangible, immediate source of calm and therapeutic benefit
for the pets’ owners. Researchers suggested that pets should be considered a primary source of support in managing longterm mental health conditions.
Lead author of the study, Dr. Helen Brooks, of the University of Manchester, noted that people interviewed through the
course of the study felt their pet played a range of positive roles, including helping them manage stigma associated with
their mental illness and provided acceptance without judgement.
Pets were also considered especially useful during times of crises, providing a form of validation through unconditional support, which was often not available from other family or social relationships. Despite often identified benefits of pet ownership, pets were not considered nor incorporated into wellness plans for any of the people in the study.
Dr. Brooks stated: “These insights provide the mental health community with possible areas to target intervention and
potential ways in which to better involve people in their own mental health service provision through open discussion of
what works best for them.”
Researchers interviewed 54 people, aged 18 and above, who were under the care of community-based mental health services, and had been diagnosed with severe mental illness. Participants were asked to rate the importance of members of
their personal network (friends, family, healthcare professionals, pets, hobbies, places, activities and objects) by placing
them in a diagram of three concentric circles. Anything placed within the centre circle was most important; the middle
circle was secondary, and the outer circle was for less important things.
Pets were found to play an important role in the social networks of the study participants, as 60 percent placed their pet
within the central circle, and 20 percent placed their pet in the middle circle. Study participants noted that their pets
helped by distracting them from symptoms and upsetting experiences, such as hearing voices or having suicidal thoughts.
Participants in the study expressed the following feelings:
“If I didn’t have pets I think I would be on my own...You know what I mean, so it’s...it’s nice to come home and, you know, listen to
the birds singing…” (First circle, 2 pet birds)
“You know, so in terms of mental health, when you just want to sink into a pit and just sort of retreat from the entire world, they
force me, the cats, force me to sort of still be involved with the world.” (First circle, 2 pet cats)
“Yes, you get comfort from them, because they lick you and all that, and they knead you with their claws and purr at you and all
that, so yes, they’re lovely.” (First circle, 2 pet cats)
“She sort of, does random stuff, like climbs on the bars and...stuff (laughs) and things which distract me, and it’s quite funny watching
her, what she does, because she’s not like a normal hamster.” (Second circle, pet hamster)
“They don’t look at the scars on your arms, or they don’t question things, and they don’t question where you’ve
been.” (First circle, pet dog)
The interviews supported existing evidence that some participants feel distanced from healthcare and uninvolved in decisions about services. A more creative approach to care planning, such as including discussions about pets, may be one way
of helping to involve participants because of the value, meaning and engagement companion animals provide. The implications of the study propose that pets should be considered a main, rather than a marginal, source of support.
Source: BMC Psychiatry, “Ontological security and connectivity provided by pets: a study in the self-management of the everyday lives of people diagnosed with a longterm mental health condition”, Helen Brooks, Kelly Rushton, Sandra Walker, Karina Lovell, Anne Rogers, University of Manchester, UK
5
Postpartum depression seems distinct from other mood disorders
New research suggests that mental disorders that often occur in association with pregnancy affect a different part
of the brain than traditional mood disorders.
Neuropsychologists used functional MRIs to study brain activity during postpartum depression and anxiety and
uncovered the distinct patterns. On the surface, postpartum depression (PPD) looks a lot like most other forms
of depression. New mothers often withdraw from family and friends, lose their appetite, and feel sad and irritable
much of the time.
Many people and clinicians have not recognized the uniqueness of mood and emotional disorders that appear during pregnancy or shortly after giving birth.
“Motherhood really can change the mother, which is something we often overlook. And we forget about examining the neurobiology of maternal mental health and maternal mental illness, particularly anxiety,” said behavioural
neuroscientist Dr. Jodi Pawluski. Pawluski, of the University of Rennes in France, was co-author of the paper with
Dr. Joseph Lonstein (Michigan State University) and Dr. Alison Fleming (University of Toronto).
Overall, functional MRI studies show that neural activity in women diagnosed with PPD, compared to people with
major depressive disorder who had not given birth, involves distinct patterns for new mothers with PPD. The
amygdala is usually hyperactive in anxious and depressed people, but for women with PPD, the amygdala can be
less activated.
PPD is now referred to as “perinatal depression,” a subset of major depression, in the DSM-5, the text which sets
industry standards for diagnosing mental conditions. Postpartum anxiety is not included at all in the DSM-5, even
though one in seven new mothers are affected by it, said Pawluski. Postpartum anxiety is estimated to be just as
prevalent as PPD, although it receives far less attention. Many of these mothers are not depressed, so their condition remains largely unaddressed. “When we talk about the neurobiology of postpartum depression and anxiety,
our information from the studies done on humans is only comprised from about 20 papers,” Pawluski said. “If
you think that 10-20 percent of women during pregnancy and the postpartum period will suffer from depression
and/or anxiety, and then you realize there are only 20 publications looking at the neurobiology of these illnesses,
it’s quite shocking.”
Postpartum mood disorders not only affect mothers, but also their infants. New mothers experiencing anxiety or
depression are more likely to report having trouble forming a bond with their baby, and are more likely to be irritated with their infants.
Early interactions can have long-term impact on infants’ health. Children of depressed mothers have higher burden of illness, use health care services more often, and have more medical office and emergency room visits than
do children of healthy women. The cost annually of not treating a mother with depression, in lost income and
productivity alone, is estimated at $7,200.
Although PPD and postpartum anxiety affect nearly one in ten women, they are still treated as extensions of major depression and generalized anxiety disorder. The experience of PPD can be further complicated by the fact
that women are expected to enthusiastically enter new motherhood. Many women with postpartum mood disorders don’t feel that they can openly discuss feeling they experience, or issues they have. New parenthood is a lifechanger, although it is not always a happy time, and it is important that the everyone recognize that, and talk
about it. Research needs to follow that will explain why pregnancy and childbirth can trigger mental illnesses in so
many women. If the health of the mother is improved, the health of the entire family will be improved as well.
Psychcentral.com/news
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F e b ru a ry 2 0 1 7
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Wed
Thu
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Sat
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23
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GA
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AA
ANX
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Mood Disorders
GA
FSG
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AA
ANX
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Mood Disorders
GA
SSRG
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AA
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CLOSED
Mood Disorders
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GA
Family Day
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AA
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ANX
Mood Disorders
Schedule of Events
ANX—Anxiety Support Group—Designed for adults 18+ as a safe place to discuss anything related to anxiety, and meet others who have gone through similar experiences. Focuses on open discussion about coping strategies, challenges, personal experiences
and more. Self-help group, with a laid-back atmosphere and friendly faces. Contact CMHA for further information. 613-549-7027 or
[email protected]
FSG—Family Support Group—Meets the first and third Monday of the month (except for holidays) at Ongwanada Resource
Centre, 191 Portsmouth Ave., Kingston. Drop-in format—no registration needed. 6:30—8:30 p.m. Contact FRC for further information
613-544-2886 or [email protected]
Mood Disorders Peer Support—Meet every Tuesday at Ongwanada Resource Centre, 191 Portsmouth Ave., Kingston. Open
group meets from 7-9 p.m.; Young Adult group meets from 5:30-7 p.m. Affiliated with Mood Disorders Association of Ontario. Drop-in
format, free and confidential. Contact FRC for further information 613-544-2886 or [email protected]
GA—Gamblers Anonymous—552 Princess St., Kingston. Enter the back door from the parking lot (ring bell). Call for details
613-544-1356 ext.4200. Wednesdays at 6:30 p.m.
SSRG—Suicide Survivors Recovery Group—CMHA sponsored discussion group for persons reconciling the loss of a loved one
by suicide, or helping another person to do so. Meets at 400 Elliot Ave., Unit 3, Kingston, every 2nd Tuesday of the month, from 7-8
p.m. Contact CMHA 613-549-7027 for more information.
AA—Alcoholics Anonymous—552 Princess St., Kingston. Enter the back door from the parking lot (ring bell). Call for details
613-544-1356 ext. 4200. Sundays at 10:30 a.m.
NAMI Family-to-Family Educational Program—Next session, Spring 2017. No cost to attend, but must be pre-registered.
Open to all caregivers of adults with mental illness. Participants gain vital information, insight, and understanding of their loved one that
many describe as life-changing. Contact FRC for information or to register.
Family Resource Centre 613-544-2886 or [email protected]
7
Psychiatrists’ experiences of suicide assessment
Clinical guidelines for suicide prevention often stress the identification of risk and protective factors as well as the evaluation
of suicidal intent. However, we know very little about what psychiatrists actually do when they make these assessments.
Semi-structured in-depth interviews were carried out with a purposeful selection of 15 psychiatrists by researchers at
Gothenburg University in Sweden.
To increase richness and variation in the interview data, a sample of psychiatrists were chosen based on age, gender, geographic location, and within-psychiatric specialization. Thirteen of the psychiatrists worked within adult general psychiatric
services (two of these were also involved in emergency psychiatric services, two worked in addiction medicine, and one in
forensic psychiatry). One further participant was a geriatric psychiatrist, and one worked in refugee services.
The analysis revealed three main themes: understanding the patient in a precarious situation, understanding one’s own reactions, and understanding how the doctor-patient relationship impacted on risk assessment and management decisions.
Emotional contact and credibility issues were common subthemes that arose then the respondents talked about trying to
understand the patient. Respondents stressed that the global impression elicited a gut feeling, but this was not something
that was taught in medical school. Rating scales were not considered helpful.
Most of the respondents brought up the importance of emotional contact. It was difficult to get a grasp on the patient’s motives and intentions when emotional contact was lacking. Assessing risk in a patient with blunted emotions was like flying
blind. Situations in which persons were mild or moderately depressed, with good formal contact but reduced emotional contact could be particularly difficult. One psychiatrist described blunted emotion as a sign of heightened risk.
“{the patient said} “I don’t want to talk to you about this”…”blunted contact was a warning signal for me here.”
Assessment was particularly challenging when substance use issues were involved.
“(there was) no resonance in the person, one got no feeling of emotion behind the words…(no) eye contact...What does he
feel? What does he think? What are his intentions?...the combination (of) lack of emotional contact and substance use, that’s what
makes it really precarious.”
Evaluation of emotional contact was something the psychiatrists learned over time. Although central to the assessment, it
was not something that could be taught in a lecture hall. Several psychiatrists described situations in which they worked to
find ways to improve emotional contact during the consultation. When such contact was achieved, the doctors felt more
secure in their suicide assessments.
Getting a grasp on the credibility of the patient’s narrative was often described as a central aspect of the assessment procedure. Many patients knew what the doctor needed to hear in order to grant ward leave or hospital discharge. Clinical impressions were stressed by respondents. Non-verbal cues were especially important. These clinical impressions translated to
a gut feeling, which was essential to the assessment process. After years of experience, the process became semi-intuitive,
and the gut feeling could help resolve credibility issues and facilitate management decisions.
Concern was expressed that relying on the gut feeling might be unprofessional. One psychiatrist described a gap between
the formal risk assessment approach taught in school and the more intuitive assessment ascertainment of risk. Attaining a
real picture meant that the doctor needed to use implicit and emotional material to draw conclusions related to care and
safety. The capability to do that was learned through clinical practice. Clinical guidelines call for structured evaluation of risk
and protective factors. Some doctors related how they assessed risk factors in the back of their minds during the consultation, rather than actually ticking off a list or filling in values on a rating scale. Several respondents stated openly that they did
not follow the clinical guidelines, concluding that they had no sense that rating scales enhanced their clinical assessment.
The psychiatrists stressed the semi-intuitive nature of their assessments. Problems related to the use of risk factor assessments and rating scales were apparent. Assessment consultations could evoke physical and emotional symptoms of anxiety,
and concerns about responsibility could lead to repressive management decisions. In situations of mutual trust, however, the
assessment consultation could kick-start a therapeutic process.
Source: BMC Psychiatry “Psychiatrists’ experiences of suicide assessment” Margda Waern, Niclas Kaiser, Ellinor Renberg,
Section of Psychiatry and Neurochemistry, Gothenburg University, Sweden.