INTEGRATIVE + ONLINE PSYCHIATRY + HOLISTIC HEALTH

Tag: holistic treatment

woman doctor checking patient's blood pressure -Copyright: rocketclips / 123RF Stock Photo

Holistic Approach to High Blood Pressure 2018

High blood pressure (BP) can be alarming when found during a medical visit or at any other time.

High blood pressure readings may be a wakeup call to take affirmative steps for your health. Natural holistic approaches, and integrative treatments, whether you are on medications or not, can help lower BP and bring benefits to important areas of your life, health, and wellbeing. Unnecessary medication use can carry the risk of falls, hip fractures, and drug-related mental and physical side effects; and more frequent visits to doctors’ offices and hospitals. A significant proportion of the U.S. national health care expense goes to treating high blood pressure. Inaccurate blood pressure measurements lead to overdiagnosis of hypertension, treatment, and use of unnecessary medications (1–4).

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scared businessman is falling into office chaos

HELP FOR ADHD – ATTENTION – FOCUS

People with attention, focus, or ADHD difficulties can be at a disadvantage in work, academic, and social situations.

ADHD (Attention-Deficit Hyperactivity Disorder or also referred to as ADD – Attention Deficit Disorder), when diagnosed, allows for a workplace or school accommodations under ADA laws (American Disability Act).  Many with less apparent attention/focus (including ADHD) problems may not be considered impaired or disabled, even though they struggle to maintain focus and attention. When someone with focus or attention issues is in a positive fit with their life situation – operating within their capacity, they are often creative, talented, and productive citizens.

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huge hurricane over Florida - hurricanes, depression, and recovery

Hurricanes, Depression, and Recovery

“Hurricanes, Depression, and Recovery” article is a story of one person’s tragedy from severe depression and hurricane losses. Experiencing a larger force of nature brought him not only to a deeper understanding of his life but to healing and recovery. The hurricane calamity also affected the multitude of people living in the same destructive path. The devastating hurricane or a storm can be compared to depressive illness: both need a path to recovery. A story presents one man’s journey of despair and loss, to redemption and healing.

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addictions, OD with pills

Addictions Uncovered

addictions, OD with pills

Current statistics show the immensity and seriousness of unrecognized substance abuse disorders and addictions.

An integrative psychiatry perspective looks beyond labels, symptoms, or a few illness characteristics to find understanding and positive treatment options for addictions.

Several questions arise about addictions.

  • Who is addicted and how is addictive illness defined?
  • Who is at risk?
  • How does addiction become a destructive disease with health and social consequences?
  • What are the indicators and early signs of addiction?
  • What are integrative psychiatry approaches to addiction, brain change, and neuroplasticity?
  • What resources are available if substance use is a problem?

How serious is the problem?

In a 1999 substance abuse survey, 14.8 million Americans used illicit drugs at least once during the prior month. About 3.5 million were dependent on illicit drugs, and an extra 8.2 million were dependent on alcohol. Only 8.1% of people with alcohol use disorders actually receive needed treatment. An estimated 30% of primary care patients with alcohol use disorders did not receive treatment. In 1992 alone, the total economic cost of addictions, alcohol, and drug abuse was estimated to be $245.7 billion – including:

  • Expense of treatment and preventive programs
  • Related health care costs
  • Reduced job productivity and loss of earnings
  • Increased crime with resulting personal and public costs
  • Social welfare needs

An addiction epidemic now exists to heroin, morphine and other prescription opioid pain relievers.

In the past decade, pain medicine prescriptions, like opiates, have increased 300%. It is estimated that two million people in the United States have substance use problems – most are from opioid pain relievers. About 26% of individuals, who are prescribed opioids for pain, develop opioid use disorders (Dr. Mercola, 2016).   “In 2015, 52,404 Americans died from drug overdoses; 33,091 of them involved an opioid and nearly one-third of them, 15,281, were by prescription,” (Mercola, 2017); (SAMHSA); (Elinore F. McCance-Katz, MD, Ph.D., 2015).

Physicians and dentists in the past were taught to treat pain with drugs, which are now known to cause addiction. Patients were led to believe that pain would be controlled with a low risk of future addiction. As a result, we are now in a national healthcare crisis. In North Carolina, since 1999, more than 13,000 individuals have died from pain medication overdoses. Last year, North Carolina dispensed nearly 10 million opioid prescriptions (DHHS Secretary Mandy Cohen, MD, 2017).

“Since 1999, opioid overdose deaths have quadrupled, and opioid prescriptions have increased markedly – almost enough for every adult in America to have a bottle of pills. Yet, the amount of pain reported by Americans has not changed. Now, nearly 2 million people in America have a prescription opioid use disorder, contributing to increased heroin use and the spread of HIV and hepatitis C. As many as 1 in 4 receiving long-term opioid therapy in primary care settings struggle with opioid addiction.” (LETTER FROM THE SURGEON GENERAL, 2017 – The Surgeon General’s Call to End the Opioid Crisis)

Addiction to refined carbohydrates, sugar, is now a major costly health crisis, contributing to obesity, diabetes, heart disease, and other significant health issues. Though a major problem, it is often overlooked, especially with the massive marketing of the sweetened products and their ready availability – as in soft drinks, and at many food outlets and restaurants. Some of the characteristics of sugar addiction are similar to cocaine addiction.

Addictions defined.

The American Society of Addiction Medicine, 2017 (ASAM) defines addiction as a “primary, chronic disease of brain reward, motivation, memory, and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.” Addictions present characteristically in several ways:

  • Pathologically pursuing of reward and relief by substance use and other behaviors
  • Inability to consistently abstain
  • Impairment in behavioral control
  • Craving
  • Diminished recognition of significant problems with one’s behaviors and interpersonal relationships
  • Dysfunctional emotional response
  • Cycles of relapse and remission

The Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) from the American Psychiatric Association replaced the term addiction with “substance use disorder.” The replacement was done because of the term, “addiction’s” uncertain definition and possible negative connotations. Also, it was felt that “substance use disorder” would be a more neutral term and describe a wider range of dysfunction, from mild to the severe state of “chronic relapsing compulsive drug taking and alcohol use.” However, the word “addiction” is still commonly employed in the USA and other countries where there is the persistence of severe substance abuse problems.

The DSM-5 describes alcohol and opioid in a similar manner as both are considered “use disorders with a problematic pattern of use leading to clinically significant impairment or distress.”

The manifestation is demonstrated by at least two significant occurrences within a 12 month period:

  1. The substances are taken in larger amounts or over a longer period than was intended
  2. There is a persistent desire or unsuccessful effort to cut down or control the substance use
  3. Lots of time is spent in activities necessary to get the substance, use the substance, or recover from its effects
  4. Craving or a strong desire to use the substance
  5. Continued use, despite having persistent or recurrent social or interpersonal problems, caused or exacerbated by effects of the substance
  6. Important social, occupational, or recreational activities are given up or reduced because of the substance use
  7. Recurrent substance use in situations in which it is physically hazardous
  8. Continued use despite knowledge of having a persistent or current physical or psychological problem that is likely to have been caused or exacerbated by the substance
  9. Tolerance, which develops, is defined as a need for markedly increased amounts of the substance to achieve the desired effect. Also, there is the occurrence of a diminished effect with continued use of the same amount of the substance
  10. The withdrawal shows the characteristics withdrawal syndrome for the particular substance
  11.  Related substances are used to relieve or avoid withdrawal symptoms (American Psychiatric Assoc. Publishing 2013) (DMS-5)

There are many factors that can increase the risk of developing an addiction.

A family history of addiction can increase the likelihood of substance use disorders in relatives. A National Co-morbidity Survey showed that individuals with a mood disorder are 2.3 times more likely to have a substance use disorder than those without a mood disorder. For bipolar disorder, there is 9.7 addiction, depressiontimes greater chance of having alcohol dependence and 8.4 times higher chance of having another type of drug dependence problem. Trauma-related conditions, as the experience of a traumatic childhood or adult life events, are found to be a common substrate in addiction illness. Attention deficit (ADHD), anxiety, obsessive-compulsive, and schizophrenic disorders are associated with higher rates of substance abuse. Recognition and treatment of any condition that can potentiate or put one at risk for addiction need attention as soon as possible (see reference and resource page).

There are early warning signs of drug and alcohol abuse.

  1. Increased drinking or use of other drugs
  2. Changes in job or school performance
  3. Changes in attitude and mood as depression, irritability, suicidal threats, or actions
  4. Unexplained changes in eating, sleeping habits, physical appearance, physical complaints, blackouts, or temporarily memory loss
  5. Behavioral problems as dishonesty, sexual promiscuity, and stealing
  6. Change in relationships especially with new friends known to drink or use drugs
  7. Alcohol on breath, slurred speech, staggering, appearing spaced out
  8. Missing alcohol, medications, or money from around the house
  9. The presence of drug paraphernalia as pipes, pill boxes, etc.

Recognition, early interventions, and treatment are critical.

The goal would be to reduce pain and suffering and the staggering cost to society. Because addictions can switch, all types of addictions need early recognition and intervention. Examples would be compulsive eating, gambling, the Internet, computer, sexual, and pornography addictions (see Addiction Reference and Resources page); (Hugh Myrick, MD, 2016).

There are valuable screening tools and questionnaires that are available to identify addictions. The AUDIT for alcohol (WHO) and the SBIRT (SAMSHA) for alcohol and substance abuse are helpful (Marc Schuckit, MD, 2014).

It is useful to learn how the brain develops, perpetuates addictions, and how it can heal itself. There are robust mechanisms in our nervous systems and brain that serve positive purposes. Theses critical brain operations are for survival, food, shelter, reward, gratification, and reproduction. The same processes are also the miraculous pathway for the achievement of success and accomplishments. Misdirection can occur however into debilitating addiction and substance use disorders (William Yvorchuk, MD, 2015).

New findings in brain research give promise for successful addiction treatment.

The brain can adapt, change, and lay down new neurocircuitry (nerve pathways).  Less used neurocircuitry are removed in a healing and regenerative process. Information is needed about the brain’s operations, functioning, and influencers. The application of gained knowledge in neuro research can lead to positive treatment outcomes. The goal would be for prevention, restoration of health, and addiction recovery.

“Neuroplasticity” is the descriptive name for the ability of the brain to change. This process represents the changes that can occur with training and to positive addiction treatment programs. Change in neurotransmitter patterns can result in new positive habits and behaviors. The training, repetition of positive experience in supportive social settings supports these brain changes (Ron Parks, MD, 2016); (Frank Lawlis 2015).

Other approaches as trauma-oriented therapies as EMDR and Spiritual Emergence are potentially valuable additions to treatment programs. The Center for Spiritual Emergence,  as an example, aims to help people live to their fullest potential. A transpersonally-based, systems-oriented, body-centered, and trauma-integrated approach is provided to foster healing and spiritual emergence from spiritual emergencies, mental health issues, and substance use disorders. The physical, emotional, mental, social, and spiritual dimensions of patients’ concerns as well as health and wellness are addressed as a pathway to wholeness.

Integrative and comprehensive approaches to addiction treatment are essential.

A thorough approach to addiction treatment looks at environmental, child to adulthood influences, psychosocial factors, trauma, and neuro-developmental issues. The importance of how other factors affect brain processes and human behavior need continuing investigation.

An intervention or treatment program can be set-up once a qualified individual or program completes an addiction assessment. An Integrative Psychiatrist and Addiction Specialist addition to the treatment team is recommended as there is a high degree of co-existing problems. Co-existing issues may need attention before addiction treatment can be successful or sustained. Treatment needs to be done for contributing medical and mental health concerns. Areas of concern may be nutritional, hormonal, allergy, immune, metabolic problems, trauma, behavioral, psychological, or emotional related conditions. Early medical interventions may look at nutritional deficiencies, inflammation, digestive, hormone, or metabolic problems as insulin resistance, early diabetes, or thyroid problems. Deficiencies of minerals or vitamins such as magnesium, copper, zinc, amino acids, essential fatty acids, B6, B12, or folic acid all can be corrected with appropriate assessment. (see Ten Holistic Steps for Mental Health)

Integrative psychiatry and addiction programs may include:

  • Education
  • Counseling
  • Psychotherapy
  • Inpatient rehabilitation
  • Outpatient programs
  • Partial hospitalization
  • Halfway houses
  • Cognitive behavioral therapy
  • Motivational interviewing
  • 12-step  programs
  • Mutual help groups
  • Mind-body-spiritual and sensory-based therapies
  • Natural complementary therapies

Possible medication augmentation can be considered, especially when other interventions are not successful. Drugs that help reduce cravings and relapses are most effective for opioids and tobacco. The medications currently available are only moderately effective for alcohol and minimally useful for stimulants, cannabis, inhalants, other substances (Petros Levounis, 2015).

If you, or a significant other, such as a spouse, friend or employer, see early signs of addiction, do not ignore, as you may inadvertently be a contributor to the severity of the problem.

With the dramatic rise in death from heroin overdoses and the devastating effects of both drugs and alcohol on individuals, families, and children – addiction is a problem that can’t be ignored. Seek help and information for both recognition and treatment of addictions to prevent serious consequences.

Find resources locally, in your community, or on the Internet. Seek out or consult with:

  • Health care providers or your primary care physician
  • Addiction specialists, treatment centers, or programs
  • Integrative psychiatrists or, holistic health practitioners
  • Twelve step programs as Alcoholics Anonymous or Narcotics Anonymous
  •  Other resources as listed under addictions on our Resource page (see below)

The Substance Abuse Mental Health Service Administration (SAMHSA) can be contacted 24 hours a day at 1-800-622-HELP

By Ron Parks, MD & edited by Shan Parks

Questions:

What would be your first step if addiction is a concern for you or a significant other? Comment below.

References & Resources:

See: Addiction References & Resources

Awareness is often ignored, which is one of the most significant of factors for healing - opening the door to healing

Awareness – The Core of Healing

awareness opening door

“Why do you stay in prison when the door is wide open?”

From Rumi the 13th Century Sufi mystic poet

Awareness is often ignored, which is one of the most significant of factors for healing.

Developing awareness, especially to constricting attachments, is an important step in the recovery from illness and pain.  Centuries ago, the Buddha realized the link between suffering and attachment. In sickness, the mind tends to hold tightly to a narrowed set of thoughts, interpretations, and feelings. The repetitive focus leads to entrapment in the mental activity defining the health threatening conditions. The mind is naturally drawn to what is considered a threat as it then gives immediate attention to what the body needs. For healing to occur, however, there needs to be a shift towards a greater awareness and openness for new opportunities, solutions, positive health behaviors, adaptations, and skill development.

Someone who has chronic pain, addictions, depression, cancer or any life-threatening illness – experiences different levels of suffering during the disease. As a result from the illness, the person may find their mind is locked into thoughts about their losses. Fears may begin to develop regarding future difficulties. An individual may worry about death, the loss of function, or the capacity to work or care for one’s self or others. An important aspect of the healers work is to provide a listening presence, wise guidance and education. Also needed, is the sharing of techniques that facilitate the release from unhealthy attachment – especially to rigid ideas, concepts, and unproductive worries. The hope is to help alleviated pain and suffering, and to enhance healing and well-being.

The healing arts have adopted fundamental ideas, which were derived from schools of spiritual philosophy, psychology, and religion.

The value of bringing awareness to the mind’s activity are emphasized for both healer and sufferer, which then counter tendencies towards fixed or rigid ideas as well as judgments and reactions. The so-called self-ego is our developed mental sphere of self-centered awareness, which contains our patterns of reactivity and response. Tight identity with the self-ego has a relative functional role for us as it aids us in adapting, interrelating and functioning in the everyday world. This developed self-ego has locked in perceptions and ideas of what different experiences mean in regards to rewards, nourishment or threat. Depending on the type of learning, parenting and earlier life experiences, the self-ego gets imprinted with adaptive or maladaptive learned patterns, reactive thoughts (judgments), concepts, images, and responses. In the case of early life trauma, for example, patterns and reactive thoughts may be maladaptive with less flexibility to adapt to changing circumstance, which gets perpetuated as pain and suffering.    see article on: Trauma – PTSD

dark cloud to awarenessWith illness or severe loss, the developed self-concept of one’s world is held more tightly.

The person then begins to be less adaptable to change and feels more vulnerable, which intensifies his or her fear and suffering. The degree of pain depends on the level of attachment to one’s developed worldview or biased perceptions, so the tighter the attachment, the greater the person’s inflexibility –  resulting in suffering. With greater rigidity comes a lessened ability to adapt, to change, to heal or transform. It is considered a healing crisis when an opportunity exists that moves along the natural developmental lines towards openness, acceptance, flexibility and spiritual growth. If you examine the healing process and spiritual growth, the essential ingredient in both is the ability to experience or recognize a “felt sense,” which is larger than one’s embedded cluster of ideas, reactivities, and repetitive pattern of responses to experienced situations. The degree of pain depends on the level of attachment to one’s developed worldview or biased perceptions, so the tighter the attachment, the greater the person’s inflexibility – resulting in suffering. With greater rigidity comes more significant pain and a lessened ability to adapt, to change, to heal or transform. It is considered a healing crisis when an opportunity exists which moves along natural developmental lines towards openness, acceptance, flexibility and spiritual growth. If you examine the healing process and spiritual growth, the essential ingredient in both is the ability to experience or recognize a “felt sense,” which is larger than one’s embedded cluster of ideas, reactivities, and repetitive pattern of responses to experienced situations.

Attempts to define or describe the undefinable, this “felt sense” of the greater, larger, all-inclusive space of being, which can be considered the infinite space of potentiality — has led to confusion due too many concepts or terms generated from the many fields of human endeavor: as science, spirituality, religion, and mysticism.  see article on: Depression

One’s ability to gain freedom from mental or physical suffering and attachments is aided by:

  1.  realization of the healing space, which may be beyond one’s contrived limiting self-notions of what we believe
  2.  getting beyond personal rigid fixed ideas, concepts, and beliefs
  3. allowing for movement and release from repetitive thought, actions, and behaviors
  4. developing an openness to a sense of more possibilities, flexibility, fearlessness, peacefulness, and serenity

Awareness, openness, acceptance, and flexibility contributes to better life adaptation, recovery, and healing.

Being stuck in fixed behaviors or patterns may be part of the actual cause or the perpetuation of illness.

The ability to be flexible and to make a change contributes to healing. If caught in an inflexible self-ego, a clouded level of awareness, or a lack of spiritual insight, one truly is in the dance of suffering and decay; while one awaits a release to freedom, new expression, and new experiences.

Alba con cielo blu e nuvole

Most schools of spiritual development teach the importance of following some form of regular practice. Gradual movement is encouraged – from rational thoughts, feelings, emotions and body awareness, to the freeing experience of the profound silence and serenity – as in prayer, meditation or contemplation. The release into the peace of “open awareness” goes beyond the usual mental activity of interpretation and judgment.

Each tradition has teachings related to:

  • the care and nurture of the body, mind, and spirit
  • the achievement of greater happiness
  • the gaining of freedom from the bondage of entrapment in a shallow, unenlightened world of an inflexible self-ego.

With development and practice, the division of self-ego and the spiritual awareness melt away into an experience of oneness and unity.

The progression to enlightenment often follows a course of gradual awakening of awareness, along with total acceptance of change and impermanence, which allow one to experience the deep witnessing that is always eternally present. The experience of an enlightened consciousness can either happen as a sudden shift, or as a mere glimpse in the course of practices, or may occur after some catastrophic event or bout of severe suffering. Integrative psychiatry and nondual therapies support and nurture the development of a stronger, yet flexible sense of self, self-awareness and self-esteem as part of the healing process. The goal is to promote a better functioning and adaptability to everyday life stresses. At the same time, work is done to enhance the individual growth and development beyond the personal self –  as well as the entrapping experiences of everything being about me or mine, to the deeper and more expansive realm of spiritual realization.  This exists as the natural state of peace, happiness, well-being and release from suffering. See article on: The Secret

Some practices to consider, for integrative healing and joyful progress, which are along the different lines of personal, compassionate, and balanced development of a healthy body, mind, soul and spirit:

  • nondual oriented therapies
  • active, consistent exercise, along with a balanced program of rest and recreation
  • yoga, chi gong, and meditation
  • spiritual practices from either one’s background, or from other religious or spiritual traditions
  • addiction and substance abuse treatment – if needed
  • reducing exposure to harmful environmental toxins and allergens
  • correction of medical, metabolic or hormone issues
  • following a more nutritious, organic, plant-based diet with correction of deficiencies — vitamins, minerals, and essential fatty acids; and health enhancement with herbs and botanicals
  • massage, acupuncture, deep relaxation, and other body-based therapies
  • “other-serving,” volunteer and community service work; charitable and compassionate assistance to others in need; caring for a pet
  • communing with nature and caring for the environment (personal and outside).

Study with a credible, well-trained and trustworthy nondual therapists, a spiritual teacher or a mentor when the opportunity presents itself. Read and study – individually or in groups – the writings and teachings of the great spiritual teachers, as well as other philosophies, and traditions. Be compassionately present. Be who you are, fully aware, liberated and open to the all existing potentialities — not a “who” that is constricted by limiting mind programming, learning, or limiting sets of reactivity patterns as from trauma experiences.

written by Ron Parks, MD, edited by Shan Parks

Resources and References:

Website/Book – In Touch

Book – The Sacred Mirror

Book –  Listening from the Heart of Silence

Article –  The Fourth Wave of Behaviorism: ACT, DBT, and Nondual Wisdom

Website: Radiant Mind

Question:

Have you had a deep awareness or awakening experience that has brought a positive change in your personal healing or recovery? Please share if you wish or comment.

Man with PTSD, terror, trauma

PTSD, Terror and Trauma – Holistic Approach

PTSD, terror, trauma  – how common and what to do after recognition?

A greater number of people, appear to be now having more exposure to terror events, trauma and are developing an increase in trauma-related illnesses, including PTSD. The causes could be attributable to any of a long list of suspected or debatable factors. It is valuable to focus on what we do know about trauma and the development of trauma-related illnesses, so as to work effectively on prevention, early recognition, treatment, and recovery.
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Are there more sensible and holistic approaches to trauma related problems?

About seventy percent of adults in the U.S. have experienced a traumatic event at least once in their lifetime. Ten percent or more of these people will develop PTSD according to some studies. Women are about twice as likely as men to develop PTSD (one out of nine women); see more at ptsdunited.org..  About 8 out of every 100 people (or 8% of the population) will have PTSD at some point in their lives. About 8 million adults have PTSD during any given year, which represents only a small portion of those who have experienced trauma; see more at ptsd.va.gov.

When you look at current statistics on PTSD (Post Traumatic Stress Disorder) and TRI (Trauma Related Disorders) – also referred to as Trauma Spectrum Disorders – two immediate questions come to mind. Is it a growing epidemic, or is it an expected outcome from the level of dysfunction and violence in our society — in our homes, on the street, in the workplace or on the battlefield? If the answer to both questions is yes, and if we are seeing more victims and sufferers from the effects of trauma, what then can we do as individuals and as a community? Can there be hope for a more sensible, comprehensive approach to include prevention; earlier recognition of the acute and lingering effects of trauma; timely interventions; proper diagnosis; application of more holistic, integrative and innovative treatments; and improvement in availability of services and resources.

Most people would not expect trauma-related illnesses and PTSD to show up from events which can occur outside of the military. Most people who are affected often go unrecognized and never seek treatment. They continue to suffer the ill effects of trauma and its aftermath.

Now it is recognized that the effects of trauma and it aftermath can occur to anyone at any life stage – childhood or adulthood.  The trauma itself can result from a wide variety of experiences:

  1. Exposure to threatened death, serious injury, auto accidents or violence
  2. Feeling helpless during a trauma as childhood sexual abuse, rape, physical assaults
  3. Major overwhelming adverse life threatening events (early life or in adulthood) or poly-trauma (i.e., series of traumatic events: as a job loss, divorce, death of a significant other)
  4. Sudden or major emotional losses
  5. Witnessing domestic violence, death or injury to others
  6. Natural disasters or mass causality event as a terrorist attack

The list of the many different types of trauma is extensive and affects each person differently.

There are a number of contributing factors that can make an individual more vulnerable to PTSD or TRI including earlier life traumas as listed above and some of the following additional vulnerability factors:

  1. Having less social support
  2. History of another physical or mental health problem such as a co-morbid substance use disorder
  3. Recent losses
  4. Contributing genetic factors

Martha is a survivor of terror and trauma.

Martha* was a well-liked and very effective 8th-grade teacher in her inner city school. Her students admired her for her understanding, effective teaching and leadership in several extracurricular programs – as the school drama club. She came to work one day, visibly shaken, reporting that two older teens had pushed her down and stole her purse when she was leaving her house – in what she thought was a safe neighborhood. She was upset and anxious for most of the day and the next, but she seemed to get back to her usual self and pace by the third day. Two weeks after this occurrence, arriving at school a half hour early to catch up on some paperwork, she was suddenly shoved through the entrance door by a large man from behind, causing her to fall to the ground. She started to scream but stopped when hit by the attacker with a glancing blow on her arm with a gun. Some other staff and students began to arrive, causing the nervous assailant to turn and flee. Martha went to her physician, and he found no physical injuries or any evidence of head injury. He offered some tranquilizers, which she refused. After a few days, she felt well enough to return to work. Over the next few weeks, going into a month, she felt easily distracted, began to startle easily, especially to sudden movement or noise. Her sleep was often disrupted with nightmares of being attacked or chased. For the first time, she began having what she and others described as panic attacks – with the sudden onset of a pounding rapid heart, an overwhelming feeling of dread that something terrible was going to happen and an urge to flee or leave the room. She could no longer drive herself as panic attacks would occur while driving. She had to take sick leave from her teaching work, and she sought out professional help.

The first doctor felt she had ADHD or attention problems and prescribed a commonly use stimulant type drug to help her focus.  This only made her worse: more anxious with difficulty sleeping, jumpy and irritable. She went to someone else who felt that her main problem was depression and anxiety — he tried her on an antidepressant that again seemed to make her worse. When he wanted to change her to a bipolar condition medication, she decided to go to another health care provider. The therapist, who saw her, recognized the impact that the trauma experience was having on her. The therapist recommended someone specialized and experienced with specific trauma-related therapy and treatment. She also saw a holistic physician that helped her improve her lifestyle, nutrition and exercise program. Martha reported that she had been sexually and verbally abused as a child growing up with an alcoholic mother and often absent father. She was often bullied by her peers as she was somewhat shy as a child. Her recovery was gradual, but Martha was able to resume her effective classroom work with her students after three to four months.  *(To protect confidentiality, the above is a composite of some clinical experiences and does not represent an actual person or any prior patients).*

The annual cost to our medical care system for PTSD and TRI is staggering – in the billions of dollars, which is often compounded by misdiagnosis and improper treatment. Beyond the actual treatment costs, there are the related workplace costs; drug costs; and cost of other associated illness, disabilities and mortality.

It is estimated that 80%-90% of persons exposed to the various types of severe trauma will not develop PTSD. Predisposing — vulnerability factors — are the more important deciding factors as to whether an individual gets a trauma related illness or not, more so than the trauma itself. The traumatic experience can have profound effects on some and very little effects on others who experience the same event.  What makes one more susceptible to post-trauma problems and another not – is of great interest now. Where there is more exposure, there is more potential for traumatic experiences and the occurrence of trauma related illness – as was the situation with Martha, as described above.

For a detailed description of trauma related illness and PTSD symptoms see the official DSM-5  (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5 by American Psychiatric Association (APA), available through the APA or at Amazon .

Recognizable intermittent or chronic emotional or physical symptoms that may be a sign of TRI or PTSD from prior trauma or trauma exposure may include:

  1. Re-living: People with PTSD repeatedly relive the ordeal through thoughts and intrusive memories of the trauma — including flashbacks, hallucinations, nightmares, feeling great distress when reminded of the trauma, acting and feeling as if the trauma were recurring and psychological distress
  2. Avoiding or feeling numb: the person may avoid people, places, thoughts or situations that remind him or her of the trauma, inability to recall an important aspect of the trauma; feeling of detachment or estrangement from others; isolation and withdrawal from family and friends – as well as a loss of interest in activities that the person once enjoyed; difficulty experiencing love, joy or intimacy – a restricted range of feelings; difficulty relating to others; diminished interest or participation in significant activities;  sense of foreshortened future
  3. Increased arousal as: having excessive emotions, worry and guilt; difficulty falling or staying asleep; feeling nervous, fearful; increased irritability; outbursts of anger and agitation; difficulty concentrating; being hyper vigilant, guarded and constantly alert;  physiologic reactivity upon exposure to trauma cues and having exaggerated startled responses – being jumpy
  4. Experiencing worsening physical symptoms and medical problems, e.g., increased blood pressure and heart rate, fatigue, rapid breathing, muscle tension, headaches, sweating, digestive problems, poor appetite, nausea, and diarrhea

The onset of trauma-related symptoms or illness can be delayed, emerging months after the traumatizing event. However symptoms may appear, earlier, be more subtle and difficult to recognize. Other symptoms or characteristics of TRI and PTSD that may occur include:

  •  Feelings of hopelessness, helplessness, shame, despair or sadness
  • Distrust of others
  • Self-blame, negative views of oneself or the world
  • Family, employment or school problems
  • Relationship problems including conflicts, being over-controlling, violence and divorce
  • Failure to engage in exercise, diet, safe sex or regular health care
  • Excess smoking, alcohol and drugs problems
    Violence of man against womanSee National Center PTSD Fact Sheet

More info at Medscape – does require a free registration)

An integrated holistic approach would be to bring together the tools, practices and scope of integrative psychiatry, psychology and medicine. The goal would be for early recognition, assessment, diagnosis and treatment of people with symptoms or problems resulting from trauma — including an investigation into contributing factors as those related to prior traumatic exposures; environmental, genetics, medical and psychological issues; and developmental and family history. The tools of integrated psychiatry and psychology would include in-depth clinical history and psycho-social assessment, physical examination, psychological testing, consulting with significant others – like family members, laboratory testing – and finally a comprehensive treatment program.

Treatment considerations would be:

  1. Lifestyle and nutritional improvements
  2. Reduction in psycho-social stressors
  3. Individual or group psychotherapies that address current, past developmental and trauma issues
  4. Interventions as suggested by clinical finding and lab testing

Medication use is a consideration after other contributing factors have been addressed, and non-medication interventions have not been adequate. Medications commonly considered are:

  • Selective serotonin re-uptake inhibitors for depression and anxiety (SSRIs; e.g., fluoxetine, sertraline)
  • Symptomatic treatments with sleep agents or more helpful for trauma-related nightmares in adults — prazosin — an anti-hypertensive
  • Benzodiazepines (tranquilizers)— long-term use does not appear beneficial and difficult to wean and stop
  • β-blockers — used to reduce arousal but of questionable benefit.

If there has been significant trauma and apparent TRI or PTSD — a team or network approach would be optimal — this would include health care practitioners trained in the modalities referred to above, plus the presence and needed interventions by an experienced trauma therapist. Therapy may involve different approaches depending on the training of the available trauma therapist as:

  1. Individual or group psychotherapy
  2. Behavioral or cognitive behavioral therapy (CBT)
  3. Exposure therapy, trauma-focused cognitive behavioral therapy, trauma systems therapy
  4. Body-mind therapies, somatic experiencing, eye movement desensitization and reprocessing (EMDR), Emotional Freedom Technique, Reset Therapy –  see E-book on RESET by Lindenfeld.
  5. Other natural alternatives or medication

See PTSD.VA.gov treatment of returning vets

The role of the holistic and integrative health care practitioner would be to add his unique skills and knowledge to the team or network of practitioners, experienced with the treatment and management of someone experiencing TRI or PTSD. As there is often dysfunction or problems in multiple areas, a careful and thorough diagnostic evaluation is needed. Any corrective interventions will help to alleviate symptoms or  illnesses – as treating any infections; digestive disturbance; nutritional or hormonal imbalances; allergies; drug, alcohol addiction problems; emotional and mood problems; personal or family stressors – with the goal of improving comfort, well-being, sleep and restoration; and improvement of autonomic Well-being, Peacefulnessregulation. All of these interventions would be potentially helpful in assisting recovery, along with the assistance of a trauma therapist when needed. Procedures or lab testing that is indicated would be done: as nutrition and digestive evaluation, thyroid and hormonal testing, blood chemistry as complete blood count, blood sugar, lipids, B12 and folic acid levels, vitamin D 25-hydroxy levels, and more specific and advanced testing if indicated.  If with treatment, the person can become less stressed from contributing psycho-social and medical factors, have more restorative sleep, be more free of pain and discomfort, get relief from environmental related illness and allergies, and relief from traumatic memories — there would be more possibilities for the body, mind and spirit to recover from the wounds of trauma.

Other treatments, mind-body therapies or psychotherapies, tests currently available or in development are beyond the limited scope of this article. If interested, see above linked references and my prior article and references – PTESD.

Be knowledgeable and prepared for when anybody that you know or meet with TRI or PTSD needs your support, help or encouragement. Healing or reducing somatic, emotional, mental and spiritual issues, and other factors contributing to the severity of TRI and PTSD – in conjunction with medication when needed — has the potential for relief and the reduction of  suffering from illness associated with recent or prior trauma.

Article by Ron Parks, MD and edited by Shan Parks – see related slide presentation in Library http://ronparksmd.com/jfk-lecture-092016/

[reminder]How could you be helpful to yourself or a significant other when suggestive or actual symptoms of TRI or PTSD appear? I’d be interested in your comments.[/reminder]

Pampas Grass in natural setting

Bipolar Holistic Treatment – Part 2

A Holistic integrative approach to the study and treatment of Bipolar Illness — BPI (also referred to as Bipolar or Manic-Depressive Disorder) offers a better path to disease understanding, treatment and prevention. See prior post “Holistic Approach to Bipolar Illness”.

Ben is not doing well with his bipolar illness.

Ben* is on several medications prescribed by his psychiatrist and has just come back from a recent psychiatric hospitalization for his bipolar disorder. He had been hospitalized after he had an emergency room visit for a suicide attempt, after he had taken an overdose of his medications. Prior to that, he had progressively worsening depression with feelings of hopelessness, helplessness and had lost interest in almost everything. He felt that there was no help for him as his mood cycling illness was only getting worse – even with all the medications he was taking. The medications made him feel like a “Zombie.” He was sleeping less with frequent violent nightmares that had woken him up multiple times during the night. He had periods of severe depressed mood when he would stay in bed for most of the day. He would have then have some days of feeling relatively fine.  He then would experience periods of feeling – super “hyped-up” –  full of energy with little need for sleep, talkative with racing thoughts, craving sex and food all the time, feeling like he was a famous rock star, and spending huge amounts of money on things he really didn’t need. He had lost all of his recent jobs and was now divorced from his second wife.

In addition to his regular psychiatrist, his family encouraged him to see and work with a holistic, integrative health care practitioner and therapist. It was uncovered that he also had a significant alcohol problem (as did his bipolar and alcoholic mother), a history of severe early life trauma – probably PTSD, severe gluten sensitivity, and autoimmune thyroid disease with thyroid imbalance. When he was directed to specific treatment and therapy programs for his bipolar illness, his PTSD, alcoholism, nutritional problems and thyroid disease; he was then able to work closer with his regular psychiatrist.  His medications were reduced, and for the first time he began to sleep better with less mood cycling. His new therapy work also helped him to identify and work through some painful childhood issues. He also felt that he regained his spiritual connection.

*(To protect confidentiality, the above is a composite of some clinical experiences and does not represent an actual person or any prior patients).

Finding a better model for helping BPI.

A broader open health-care model offers the potential for improved research, diagnosis and treatment of BPI. All disciplines can be included in an integrative model – including biochemistry, nutrition, psycho-pharmacology, psychiatry,  genetics, spirituality, psychology, sociology, physiology, endocrinology, environmental medicine and complementary mind/body/spiritual therapies. Effective outcomes can happen with patience, and the commitment to finding a suitable care and treatment program.

Early recognition, comprehensive assessment and an integrative approach to treatment – including natural therapies – can help bipolar sufferers improve their chances of stabilization, improvement in relationships, and productivity and work. As proper assessment and diagnosis can be of critical importance, seeking out skilled and experienced health-care practitioners is important – such as a psychologist, a psychiatrist, and/or a holistically oriented health-care provider who is trained in mental health work.  People with bipolar illness are sometimes misdiagnosed as having just depression or other conditions – and treated as such – often resulting in a poor treatment outcome.  These individuals would have responded better to a broader holistic and integrative type of treatment program that had benefited Ben’s recovery as described above.

Every individual is unique in their treatment needs.

Woman with Bipolar Disorder
©Sangolrl/Dollar Photo Club—Balancing Act.

Any individual who has difficulties with mood changes is unique regarding their treatment needs.  BPI can be influenced by factors as:

  • a person background
  • earlier life experiences, exposures or trauma
  • current lifestyle, nutrition, environment
  • individual medical issues, genetics
  • personality
  • psychological or addiction issues
  • traumatic brain injury

A person’s capacity to grow in awareness, learning, and to succeed with lifestyle changes will influence the choices and success of any selected treatment. As there are many individual differences as well as variation in the type and severity of bipolar conditions, the needs and type of treatment will vary or differ from person to person.

Natural non-medication approaches

Some of the non-medication or more natural approaches would be:

  1. improving lifestyle, nutrition, exercise and sleep
  2. addressing environmental issues
  3. stress management
  4. individual or group psychotherapy
  5. avoidance of alcohol and substance abuse
  6. education, behavioral, family, cognitive or trauma therapy
  7. other complementary mind-body-spiritual oriented programs.

Other complementary practices or therapies would be:

  • relaxation training, yoga
  • Oriental Medicine, acupuncture
  • religious, meditation and spiritual practices
  • regular exercise and sleep
  • use of fish oil, rich in EPA and DHA – has been shown to complement other treatments of BPI.

There is a body of work suggesting that nutrition and certain dietary programs can help in treatment of mood disorder, as a diet:

  1. high in healthy fats
  2. high in vegetables, rich in minerals and anti-oxidants
  3. adequate in good quality protein
  4. low in sugar and starches
  5. that avoids gluten (found in wheat, rye and barely — felt to be a trigger in some people for inflammation and auto-immune diseases). (see Grain Brain)

Specially designed light boxes, if carefully used under the guidance of an experienced health-care provider, are sometimes useful (especially if there is a seasonal component to the depression and mood cycling). Assessment and correction for any nutritional, metabolic, hormonal (as thyroid deficiencies), allergic or environmental problems need to be considered.

A genetic biochemical problem that can be improved with nutrition, called hypomethylation is worth assessing – as there is evidence that it affects the expression of bipolar symptoms – and if treated can bring benefits and improve outcomes. Methylation is also relevant to drug-nutrient interaction in the treatment of BPI and is one of possible underlying factors that can contribute to medications not working effectively. (see  “Bipolar Disorder” by Vinitsky and Parks, Advancing Medicine with Food and Nutrients, 2nd edition, Chapter 32, Dec. 2012, CRC Press)

Medication considerations

Some of the conditions or consideration for medication interventions and treatment are:

  • worsening of BPI with poor response to non-medication approaches
  • development of thought or cognitive impairment such as psychotic symptoms with delusion, hallucination or dangerous behavior, especially when accompanied by poor judgment and risk of self or other harm
  • actual or imminent need for a safe protective environment — psychiatric hospitalization
  • lack of capacity or willingness to follow non-medication treatment regimens or protocols
  • personal choosing of medication treatment over non-medications (after being fully educated about all options, including therapy programs or natural alternatives – other than medications) about risk of using medication vs. not taking them, potential for adverse immediate or long-term risks, or side effects from medication

According to some studies, those with bipolar disorder – not treated with appropriate medication or a mood-stabilizing agent when needed – have a significant increase risk of a more chronic condition, more frequent relapses of the illness and more severe outcomes – as suicide*.  More than 50 percent of people will abuse drugs or alcohol if the disorder is not recognized or treated.

Concerns about medication and risk:

  1. potential for short term, long term, or potential side effects: including weight gain, diabetes, metabolic problems, high blood pressure, heart disease, abnormal restlessness and/or involuntary movement disorders of face, mouth and limb (mostly a risk with anti-psychotic medication and possibly from some of the antidepressants)
  2. potential for making mood cycling worse or triggering more severe episodes of mania or psychosis.

So it is important for the individual to be educated about the use medication, benefits and risk – weighing the potential benefits of medication being helpful – especially in a well designed comprehensive treatment program – vs. risks of medication use and side effects.

There are several classes of medications considered when felt necessary in BPI, including:

  1. Anti-depressants: as citalopram and sertraline, which are selective serotonin re-uptake inhibitors – SSRIs that increase the amount chemical nerve factors (neurotransmitters) that helps relieve depression
  2. Anxiolytics (anxiety reducing medication) such as: benzodiazepines such as clonazepam and lorazepam that support the neurotransmitter GABA which helps relieve anxiety
  3. Mood Stabilizers as lithium, valproate and lamotrigine that helps to balance and stabilize brain activity and neurotransmitters (active brain chemicals) which sometimes have an antidepressant effect – as lamotrigine
  4. Antipsychotic Medication as: aripiprazole, risperidone, and lurasidone: helps to eliminate or reduce psychotic thoughts, which is abnormal or disturbed thinking as delusions and hallucination, helpful in reducing agitation, helpful with mood stabilization and sometimes helpful in reducing depression; read more: nimh.nih.gov/health

Fantastic sunset
©Allk Mullkov/Dollar Photo Club—Beauty in Nature.

Appreciating the many facets of BPI, the varied presentation and potential for adverse impact on people’s lives underscores the importance of early recognition, thorough assessment, and initiation of comprehensive and holistic/integrative treatment as outlined above. Effective treatment of BPI sufferers can potentially bring a return to a more stable, functional, fulfilling and productive life.

*If you or some one you know is thinking about self harm or suicide, seek help immediately (Call your doctor, 911 or go to a hospital ER, or Call the 24-hour National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).

Article by Ron Parks, MD; edited by Shan Parks

For additional help and resources check below links:

(psych.com/guides)

(dbsalliance.org/)

(NIMH on Bipolar Disorder)

(adaa.org/)

Question:

What would be your consideration and options if you feel that you or a significant other has difficulty with a bipolar illness? I would be interested in your comments.

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