I have a weight bench in the bedroom and I usually watch PBS while I lift. Of course, this is usually weekday evenings, not weekend mornings, so imagine my surprise when I turn on the TV and, instead of the gentle, soothing voice of Jim Lehrer, I see Dr. Mark Hyman peddling his UltraMind Solution.

I didn’t watch long because I read somewhere that it’s bad to vomit while weightlifting. But I wanted to touch on some of the stuff Hyman said. The first, that studies have shown that autism has been linked with diseases of the gut, had me in stitches. The problem is that those studies have been discredited, and considering that Wakefield did his study on a huge sample of 12 people, I don’t know how valid the results could be.

We now know that mercury is toxic.

Actually, we’ve known that mercury was poisonous since at least 1926. However, there are still commercial applications that need mercury, so we still have to use it and be cautious of its environmental effects. But don’t make it sound like mercury poisoning is a new concept.

We use special chemicals that bind with the mercury.

Chelation. He is talking about adults here, so I’m not going to go on a rant about chelating children. He is specifically talking about an adult who lived near a concrete plant. In this case chelation would be appropriate. However, Hyman makes it sound like everyone needs chelation. This is akin to comparing the effects of environmental radiation from someone who lived at Chernobyl to someone born and raised in Nebraska.

Stress shrinks the hippocampus.

This article from Harvard psychologist R.J. McNally refutes this mind myth, giving us a number of studies showing that the atrophy theory is bogus.

Stress lowers serotonin levels in your brain.

I have a problem here. While I can’t find anything reliable that directly relates high stress and low serotonin, it is logical. However, studies have shown that serotonin is released during exercise, and exercise is physically stressful.

But that’s not the real problem. The problem is: so what? People seem to think of serotonin as a miracle, cure-all neurotransmitter, like if they can just get more and more serotonin they would be fine (when, in fact, it makes people ill. It’s called serotonin storm). It’s the same irrational logic that steroid-users present after they’ve shrunk their testicles and grown bitch tits (thank you, Chuck Palahniuk, for such a wonderful term). There can truly be too much of a good thing.

We need stress. We thrive on it. Stop making stress out to be a demon. It is by facing stress that we change, and we face stress as we change. You can point to happiness as the key to a healthy life, but if you’re smiling and laughing in the middle of a firefight, there is something wrong with you.

I’m going to stop here before my head explodes from the stupid. I didn’t link to any of Hyman’s web sites (you’re welcome), but if you want to find this guy, just Google him.

I came across a situation late this week that illustrates how difficult it is for people to lose weight. On Thursday evening I got a call from a close friend and spent the night talking, so I ended up skipping my 1/2 hour cardio. Last night the wife wanted to watch Rescue Me, as she still has to catch up to me, so I skipped it again. I also skipped weightlifting.

Now it’s Saturday. If I wasn’t writing this blog, I may skip the stuff today, too. Now I have someone (my readers) to answer to. So it’s weightlifting and cardio today. I was planning to do some outdoor jogging today, but we’re getting April Showers early, so I guess I’m working off the DVD again.

So this will be a series on this blog. I figure if I make my wins and losses public, I may be a little more motivated. I’ll give you my stats: I am a white male, 28-years-old, my height is 5’11”, and I currently weigh 324 pounds (I just weighed myself this morning.) Last Thursday I weighed in a 331, so the first step, drink more water, is helping a little bit.

My plan is to combine a calorie-restrictive diet with an exercise regimen that involves a ½-hour cardio workout daily (I started on Monday) and weight-lifting 3 times a week (I started that on Monday, too). I’ll be posting my weight gains and losses on the blog every Friday or Saturday.

I started this on Monday, and I was planning on doing my first post on Friday, but I read a story on the Huffington Post that I thought would be a good stepping-stone to introduce this series. HuffPo Columnist Kathy Freston writes that counting calories never works, and uses a recent Harvard study published in The New England Journal of Medicine as her proof.  The study looked at four diets in 811 individuals, limited their calorie intake to 750 calories below their daily needs, but no fewer than 1,200 calories a day. At six months the subjects had lost an average of 13 pounds and at two years they had kept an average of 9 pounds off their original weight and lost 1-3 inches off their waists.

Why is this not good news? Because, according to Freston, at 2 years people were consuming more than their allotted number of calories. So, low calorie diets don’t work when people consume a high number of calories? That’s a revelation. That should be on a billboard.

Freston then pushes a low-fat vegetarian diet that she read about in a book somewhere. After the post turned into an advertisement I stopped paying attention. I’ll be the low-fat vegetarian diet will stop working if people start consuming meats or high-fat nuts as well.

I’m going to het Dr. Harriet Hall, paraphrasing from this month’s Skeptic magazine, get the final work. Eat a little bit of everything, in moderation, mostly vegetables.

So overall I agree with Dr. Hall in that, in some cases, it should be easier to commit someone long term, and we should build long-term treatment facilities. I do, however, have 3 points of contention that I would like to address with Dr. Hall’s post.

Number 1, Hall states that “anosognosia is part of their disease… If you can’t recognize that you are ill, why would you accept treatment for a condition you firmly believe you do not have?” In my experience, and I realize that anecdote is not the singular form of data, but this has been pretty across-the-board, most people with schizophrenia realize that they are ill, but the hallucinations and delusions that they experience are so real that they can’t help believe them. They don’t stop taking medications because they do not believe they are ill, they stop because medication is not perfect and paranoia can set in during brief relapses. Every person with schizophrenia that I have ever worked with has stated that they stopped taking their pills because they thought that the pills were poisoning them. This paranoid delusion also makes people with schizophrenias more resistant to therapy because they believe that the therapist is trying to harm them.

 I’m not saying that anosognosia  doesn’t play a role, but no client I have ever dealt with has stated that they believe they were not sick. However, most of my clients with schizophrenia have been older and in the system for a while. Perhaps it would be different for someone who is recently diagnosed.

Number 2, Hall at one point leads readers to believe that someone has to have committed a violent act before they can be involuntarily committed, stating “Society will do nothing to help you until he actually hurts someone.” Laws relating to involuntary commitment are different from state to state, and it really boils down to the will of the county mental health commissioner, but in my local system the law clearly states that the individual has to be “a danger to themselves or others.” That doesn’t mean that they have had to attempt a violent act, but they must be a viable threat. I’m not saying that it is easy to have someone committed, but it is not quite as hard as Hall states.

Number 3, Hall seems to forget that the ethos of deinstitutionalization was not just to shut down hospitals, but to put more emphasis on community-based treatment. It is possible to provide a high level of care for people with schizophrenia in a community-based setting. The Title XIX Medicaid Waiver program provides funding for in home care for three distinct groups of people, the MR/DD population, the elderly, and people with severe persistent mental illness. The problem is that most waiver funding goes into the MR/DD sector, with elder care and care for persistent mental illness splitting a very small pot. If we could increase funding for mental illness care, we could provide 24-hour staffing for individuals living with severe and persistent mental illnesses such as schizophrenia.

Of course, maybe one of the problems is one of categorization. We classify MR/DD disorders as Axis II disorders and schizophrenia as an Axis I disorder, despite the fact that both of these disorders appear, if current research is correct, to be fully caused by a person’s genetics and biology. However, the typical age of onset of schizophrenia, late teens to mid twenties in men, early twenties to early thirties in women, leads many to believe that schizophrenia has some sort of social/environmental cause. Mental retardation appears at birth. Schizophrenia takes a while.

Of course, as I type this, a group of doctors are meeting privately to decide the content of the DSM-V. Maybe this insulated group will change things. Then again, maybe not.

1. Showing Up Late for an Appointment

This one should go without saying. I can’t believe that someone would have to tell you to be in time.

2. Eating In Front of a Client

Do people actually do this? I’m only a case manager, and the place that I work has a water tower and coffee that are free to the clients and staff, so we do a lot of drinking in the office, but eating? During a session?? That’s just crazy.

3. Excessive Yawning or Sleeping During a Session

Yawning sometimes can’t be helped. It’s all well and good to say you should get a good night’s sleep, but when you work a job that has on-call hours, it isn’t always possible. Of course, explaining this to a client would be good.

6. Distracted by Phone, E-mail, or a Pet

I know someone who works in the field who will answer her cell phone at any time, with a client or in a meeting with the boss. I know some of her co-workers would like to jam that phone someplace very uncomfortable, too. It’s annoying for everyone, clients and co-workers alike. If your wife is pregnant, and she’s in the third trimester, it’s okay to check the cell phone to see if it’s her number otherwise, don’t.

And pets? Do these people even think about allergies?

5. Inappropriate Disclosures

7. Expressing Racial, Sexual, Music, Lifestyle, or Religious Preferences.

These are really the same thing. I learned early on to not let clients too far into my life, but I have seen this happen before.

I like the music thing here. I could see myself getting into an argument with a client about the greatness of Pearl Jam, or, for you old guys, the Rolling Stones vs. The Beatles.

9. Hugging or Physical Contact

I’m not a hugger. And it really tells you something about the state of mind of some people that you have to explicitly state that having sex with your client is inappropriate. There’s an old saying where we work; every rule exist because someone screwed up in the past.

11. Clock Watching

12. Excessive Note Taking

Ah, the two things I’m probably going to be most guilty of. If you don’t keep track of the time, you end up with a Number 1 with your next client. I have cut back on the note taking, though.

I have a friend who works as a counselor, and he has a good way of doing things. He lets the client stay for a whole hour instead of 50 minutes if thy want to help recap the session for the note. I like that.

You should read the whole list. It’s rather good.

Fluoxetine (you may know it better as Prozac) is the only antidepressant that the FDA approves for use with children and adolescents, and fluoxetine has been found to be effective in reducing depression and comorbid substance abuse disorders in adults. Findling et al., publishing in the Open-Access Child and Adolescent Psychiatry and Mental Health, decided to study the effects of fluoxetine in adolescents with depression and comorbid substance abuse disorders.

The study originally included 18 patients in a fluoxetine experimental group and 16 adolescents in a random, double-blinded control group. Of the subjects, 26 reported that the depression started before the substance abuse and 6 reported simultaneous depression and substance abuse. Urine screens were used to assess drug use throughout the experiment.

At the end of the study, 12 subjects remained in the fluoxetine group and 13 remained in the placebo control. Both groups had reduced symptoms, but the placebo group had a greater mean reduction in symptoms. Fifty percent of the participants in each group met the criteria for remission. (There is a great graph in the article showing the difference in scores between the two groups, but I’m working off an old computer and can’t get a really good screengrab.)

This study gives us some good data, but it is important to keep in mind the small sample size and low statistical power of the study. I like that the authors didn’t let this study become part of the file drawer problem. It is just as important to see that a psychological or medical intervention is not effective as it is to see that something is effective.

Findling, R., Pagano, M., McNamara, N., Stansbrey, R., Faber, J., Lingler, J., Demeter, C., Bedoya, D., & Reed, M. (2009). The short-term safety and efficacy of fluoxetine in depressed adolescents with alcohol and cannabis use disorders: a pilot randomized placebo-controlled trial.

UPDATE: I just read in one of John’s posts on PsychCentral that the FDA just approved Lexapro for use in children, despite some misgivings. So fluoxetine is not the only SSRI approved for children. Check out John’s post for details about the controversy.

 Child and Adolescent Psychiatry and Mental Health, 3 (1) DOI: 10.1186/1753-2000-3-11

President Obama had the decency to call Tim Shriver at Special Olympics and apologize before the show even aired, but still… It leaves a bad taste in my mouth.

C’mon, can we please get rid of those parts of our vocabulary that are offensive to people with intellectual disabilities? Do we have to use retarded when we mean stupid, or make a reference to the Special Olympics when we want to say we’re bad at a certain sport? What if I said “I did as well on my science test as an inner-city black kid?” That wouldn’t be cool! Not cool at all!

So stop it! Stop! Think before you speak, for Pete’s sake.

And don’t think Sarah Palin is on my good side because she has spoken out about the same issue. She is the political equivalent of one of those D-list actors you always see on VH1, she’ll do anything to get press. Where was she on the Dick Morris thing? Nowhere, that’s where. Nobody cares what you think. Go back to Alaska and try to explain how we rode around on the backs of dinosaurs.

In a randomized controlled study by Fairburn et al. published in the American Journal of Psychiatry, researchers studied the use of a specific form of CBT designed to treat eating disorders. There are two forms of the therapy, CBT-Ef, which is a focused form that highlights issues directly related to eating disorders such as body image, extreme dieting, binging, and purging, and CBT-Eb, a broad form which also touches on other psychopathology, such as depression, low self-esteem, mood intolerance, and interpersonal difficulties.

When the results were tallied, researchers looked at complex psychopathology and simple psychopathology. Subjects in the complex psychopathology group tended to be assessed as having more mood intolerance, interpersonal difficulties, and self-esteem issues. The results are kind of interesting:

As you can see from the graph, CBT-Ef works best with simple psychopathology, but does not work nearly as well with complex psychopathology. The CBT-Eb group shows similar results with both simple and complex psychopathology.

It looks like the focused approach is not really necessary, but can give better results when used with clients with less complex psychopathology. The broad approach seems to be preferable, but less effective.

This study shows us the importance of clinical judgment. Clinicians need to be able to assess the complexity of their clients’ psychopathology in order to find the right emphasis for therapy. In these two therapies, the first four weeks are the same regardless of whether a clinician is using the focused or broad approach, giving clinicians plenty of time to assess their clients’ needs.

Fairburn, C., Cooper, Z., Doll, H., O’Connor, M., Bohn, K., Hawker, D., Wales, J., & Palmer, R. (2009). Transdiagnostic Cognitive-Behavioral Therapy for Patients With Eating Disorders: A Two-Site Trial With 60-Week Follow-Up American Journal of Psychiatry, 166 (3), 311-319 DOI: 10.1176/appi.ajp.2008.08040608

In 1997, Nadean Cool won a $2.4 million malpractice settlement against her therapistin which she alleged that he used a variety of techniques and suggestive procedures to convince her that she had suffered horiffic abuse and harbored more than 130 personalities including demons, angels, children, and a duck.

The emphasis is, of course, mine.

If anyone out there knows how to provide psychotherapy to a duck, please let me know. If breadcrumbs are involved I want to be prepared.

Of course, the other issue is that you could never tell with any validity if the woman was a witch.