Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Examining Medical Causes of Psychological Symptoms: An Orthomolecular and Functional Medicine Approach David Reinhardt Ph.D. ABMP National Alliance of Professional Psychology Providers 2010 NAPPP Practice Conference October 9-10 Las Vegas NV [email protected] www.CenterforHealthScience.com Useful Links www.CenterforHealthScience.com Symptom Checker Discount lab service / Alternative treatment products Affiliate Program and Referral Service Power Point Presentation “Drugs That Cause Psych Effects” Excel file www.Epocrates.com Free and Fee Software for Desktop and Mobile Drug and natural medicine information Practice guidelines Many free tools www.orthomed.org www.ohmsociety.com functionalmedicine.org www.labtestsonline.org www.apexseminars.com Orthomolecular Medicine Online Orthomolecular Health Medicine Society The Institute for Functional Medicine Complete information on lab tests Lab Test courses The Doctor of the Future “The doctor of the future will be an integrative healer whose practice differs in many ways from that of today's typical physician. The doctor of the future will provide care that is patient-centered and comprehensive (body, mind, and spirit), and care that is both high-tech (using genomic prediction tools, systems biology, and functional medicine, for example) and high-touch.” “Care will focus more extensively on preventing disease and injury. The practice of the future will be provided by smoothly working teams that will include primary care physicians, complementary and alternative health practitioners, health coaches, and wellness mentors, as well as medical specialists, allied health and nursing practitioners.” (Foundation for Alternative and Integrative Medicine) “Modern” Mental Health Treatment IS NOT Modern Mental Health Science “Diagnostic Standards of Care” are poorly written and generally lacking for symptoms of mood, cognition and behavior APA Practice Guideline for the Treatment of Patients With Major Depressive Disorder May 2010 152 Page Document states "...not intended to be construed or to serve as a standard of medical care…Communication with other clinicians who are providing treatment for general medical conditions is recommended." APA Differential Diagnosis of Depression: Rule Outs: Stroke Parkinson's Dementia Multiple Sclerosis Thyroid Disorders Hypercalcemia Malignancy Infectious Diseases Medications including:Anti-rejection Agents Chemotherapy Agents Interferon Steroids Some Antibiotics Tests: No Recommendations The Merck Manual for Healthcare Professionals does better Merck Depression Chart Unfortunately, the Merck Manual is seldom followed and offers little guidance on other psychological symptoms Epocrates Inc. Software Clinical information and decision support tools Used by “over 40% of US Physicians” www.epocrates.com Offers reliable free and subscription applications for handhelds and desktop Epocrates Home Page Diagnostic Standard of Care for Depression (Epocrates.com) Differential Situational adjustment reaction with depressed mood Bipolar disorder Premenstrual dysphoric disorder (PMDD) Grief reaction Dementia Anxiety disorders Alcohol abuse Anorexia nervosa Hypothyroidism Medication adverse effects Cushing disease Vitamin B12 deficiency Tests Symptom questionnaires CBC Thyroid function tests 24-hour free cortisol Vitamin B12 Folic acid Epocrates Page Diagnostic Standard of Care for Anxiety (Epocrates.com) Differential Panic disorder Social phobia Post-traumatic stress disorder Obsessive-compulsive disorder Depression Substance-induced anxiety disorder Anorexia nervosa Situational anxiety (nonpathologic) Cardiac disease Pulmonary conditions (i.e., COPD, asthma) Hyperthyroidism Infections Crohn disease Irritable bowel disease Ulcerative colitis Asthma medications Corticosteroids Antidepressants Beta-blockers Peptic ulcer disease Tests Thyroid function tests Urine drug screen 24-hour urine for vanillylmandelic and metanephrines Pulmonary function tests Echocardiogram Electrocardiogram (EKG) Electroencephalogram (EEG) Epocrates Page Diagnostic Standard of Care for Insomnia (Epocrates.com) Differential Restless leg syndrome Periodic limb movement disorder Obstructive sleep apnea Circadian rhythm disorders Tests Symptom questionnaires Polysomnography Sleep Diary TSH Epocrates Page Diagnostic Standard of Care for Schizophrenia (Epocrates.com) Differential Substance-induced psychotic disorder Dementia with psychosis Malingering and factitious disorders Delusional disorder Brief psychotic disorder Pervasive developmental disorder Organic psychosis Carbon monoxide poisoning Heavy metal poisoning Medication-induced psychosis Liver disease Hyperthyroidism Hyperparathyroidism Tests CT/MRI head Serum HIV Serum rapid plasma regain CBC Urine drug screen Plasma drug level monitoring Epocrates Page Diagnostic Standard of Care for Bipolar Disorder (Epocrates.com) Differential Mood disorder due to general medical condition Substance induced mood disorder Major depressive disorder Dysthymic disorder Cyclothymic disorder Psychotic disorders Personality disorders Obsessive-compulsive disorder ADHD Tests Symptom questionnaires CBC Thyroid function tests Serum Vitamin D Toxicology screen Fasting lipids Fasting glucose MRI brain Epocrates Page Diagnostic standard of care for OCD (Epocrates.com) Differential Obsessive-compulsive personality disorder Body dysmorphic disorder Hypochondriasis Delusional disorders Severe social phobia Panic disorder Autism Asperger syndrome Tests Symptom questionnaires No lab tests recommended Epocrates Page Diagnostic Standard of Care for Dementia (Epocrates.com) Differential Mild cognitive impairment Delirium Depression Vascular dementia Dementia of Lewy body Frontotemporal dementia Parkinson disease Creutzfeld-Jacob disease Tests Cognitive testing CBC Erythrocyte sedimentation rate Metabolic panel Serum TSH Serum B12 Serum VDRL Epocrates Page All of these approaches, if followed, allow the patient to be put into a diagnostic box Treatment consists of prescribing psychotropics and, hopefully, psychotherapy Current practice guidelines have 2 things in common... Treatments mostly suppress symptoms Causes are seldom explored “Modern” Medical Treatment IS NOT Modern Health Science A branch of healthcare has looked to treat CAUSES since the days of Ancient Civilizations It has been MARGINALIZED by “Modern Medicine” It offers limited profit potential for drug companies Psychology! Another branch of healthcare has been similarly marginalized by Modern Medicine It too has limited profit potential for drug companies Orthomolecular Medicine “Critics have described some aspects of orthomolecular medicine as food faddism or quackery.” (Wikipedia) Orthomolecular Medicine draws on health knowledge with roots in pre-history It reflects the most recent science, learning from the discoveries of genetic research and bioscience “Orthomolecular medicine aims to restore the optimum environment of the body by correcting imbalances or deficiencies based on individual biochemistry” (Linus Pauling) “Orthomolecular practice rests on a foundation of basic science advances in biochemistry, biophysics, genetics, physiology, psychophysiology and ecology. We do not eschew drug therapy or pharmacology; but we do recognize their limitations and their potential for toxicity.” (Richard Kunin) Orthomolecular medicine uses substances natural to the body such as vitamins, minerals, amino acids, trace elements and fatty acids Orthomolecular Medicine has a Big Tent Orthomolecular Medicine uses: Vitamins Minerals Amino acids Essential fatty acids Fiber enzymes Antibodies Antigens Cell therapy Acupuncture Massage Exercise Biofeedback Chelation therapy Dialysis Plasmapharesis Hydrotherapy Thermal therapy Phototherapy Electrotherapy Air ion therapy Light Therapy Solar therapy Hypnotherapy Psychotherapies 7 Cardinal Rules of Orthomolecular Medicine 1. Nutrition comes first in medical diagnosis and treatment 2. Drug treatment is used only for specific indications and always with an eye to the potential dangers and adverse effects 7 Cardinal Rules of Orthomolecular Medicine 3. Environmental pollution and food adulteration are an inescapable fact of modern life and are a medical priority 4. Biochemical individuality is the norm in medical practice; therefore stereotyped RDA values are unreliable nutrient guides 7 Cardinal Rules of Orthomolecular Medicine 5. Blood tests do not necessarily reflect tissue levels of nutrients 6. Nutrient diagnosis is always defensible because nutrient related disorders are usually treatment responsive or curable 7. Hope is an indispensable ally of the physician and an absolute right of the patient (Richard Kunin) Orthomolecular medicine does not purport to treat all diseases, nor is it "a replacement for standard treatment. A proportion of patients will require orthodox treatment, a proportion will do much better on orthomolecular treatment, and the rest will need a skillful blend of both” (Abram Hoffer) Functional Medicine puts a fresh name to the core concepts of Orthomolecular Medicine The Institute of Functional Medicine was founded by Jeffrey Bland in 1991 Orthomolecular/Functional Medicine identifies and treats using a 3 prong approach: Antecedents Triggers Mediators ANTECEDENTS Are things that happen before disorders starts • Genetic Variations • Genetic Regulation • In-utero Exposure • Early Life Exposure Genes control the formation and structure of nutrient and neurotransmitter receptors Genetic variations influence metabolic pathways and lead to the “Neurotransmitter Imbalances” claimed by the drug makers Genetic variations can impair absorption of sufficient nutrients, leading to mood, behavior and physical symptoms TRIGGERS Things that unmask your antecedents They are involved in REGULATION and EXPRESSION of particular genes Early life events may alter gene expression through: •Viral Exposure •Radiation Exposure •Drugs •Environmental Pollutants Orthomolecular Scientists counsel to avoid disorders caused by antecedents through appropriate lifestyle, nutritional supplementation, diet, and shunning of additives and industrial pollutants. Nutrients may be used as a “workaround” to impaired metabolic pathways at the Trigger level. Example 5,10-methylenetetrahydrofolate reductase (MTHFR) polymorphisms impair conversion of folic acid to methionine, resulting in increased risk of: Coronary Artery Disease Inflammatory bowel disease Depression Down’s Syndrome Alzheimer’s disease (possibly) MTHFR variant C667T Occurs in: 26.6% of Whites 12.4% of Blacks 41.5% of Hispanics Identification of MTHFR related risk can be made by: Genetic testing Nutrient testing Interpretation of subtle symptoms Best guess Typical Orthomolecular Intervention: Supplemental Folic Acid! Taking high dose supplemental folic acid “pushes” the metabolic pathway to create sufficient methionine. This is safe, and has no adverse effects. MEDIATORS Are those things your body does to try to rectify the consequences of the antecedents and triggers Feedback loops are Mediators that attempt to compensate for imbalances in an attempt to reach homeostasis Mediators are very effective at rectifying imbalances due to drugs These feedback loops are the Achilles’ heel of Modern Medicine Orthomolecular/Functional medicine tries to understand antecendents and intervene at the trigger level. Modern Medicine understands mediators and intervenes at the symptom level. That is one of the fundamental differences between the two disciplines A Proposed Diagnostic Protocol for Assessment of Mental Health Symptoms 1. Diagnostic Interview Symptom Questionnaire Symptom Checker 2. Medication Review Appropriateness of Dosage Adverse Effects Interactions Checker Consult when beyond your level of expertise Abilify Drugs Excel 3. Consider Possible Alternate Explanations Consult! www.wrongdiagnosis.com www.CenterforHealthScience.com CHS depression 4. Recommend or Obtain Medical Labs to rule out physical causes For Information on Lab Testing: labtestsonline.org CenterforHealthScience.com Apexseminars.com Depression Labs Apex 5. Refer for Treatment! Allopathic Physician Naturopathic Physician Doctor of Oriental Medicine Ayurvedic Physician Medical Psychologist Nutritionist Other Professionals Qualified Referral Sources Institute of Functional Medicine members: www.functionalmedicine.org Orthomolecular Health Medicine members: www.ohmsociety.com ISOM Members: www.orthomed.org Center for Health Science: www.centerforhealthscience.com