Compliance with recommended treatment, or treatment adherence, is a very important clinical issue. In fact, nonadherence to medications poses one of the greatest challenges in the treatment of patients with psychiatric illnesses.
According to some studies, more than 50% of psychiatric patients do not comply with their medication regimens. Nonadherence with prescribed medications can be intentional or unintentional. Intentional nonadherence may be the result of fear of side effects, concerns regarding the stigma of mental illness, inconvenience of dosing medications, or the cost of medications.
Unintentional nonadherence, on the other hand, is more likely to be the result of forgetfulness or lack of insight as to the importance of treatment compliance. Nonadherence to recommended psychiatric medication regimens is linked to poorer outcomes, including increased hospital admission and disease relapse or exacerbation.
Talk to your provider if you have concerns that may lead to medication nonadherence. At PFHL, we believe in working with our patients to develop the most effective treatment strategies. And treatment is never effective with poor medication adherence.
Here are some tips to increase medication adherence:
 Understand your medication. Talk to your provider about what medications you are taking and why. When you understand the benefit the medication provides, you are more likely to be adherent to your medication regimen.
 Talk to your provider about any concerns you may have. There may be ways we can help alleviate side effects or mitigate the cost of medications.
 Use a pill reminder app or set an alarm or calendar alert on your phone to remind you to take your medication.
 Tie your medication doses to a daily activity. For example, keeping your medication with your toothbrush ensures that you see the medication daily (or hopefully, twice daily), which will serve as a visual reminder to take your pill. Pretty soon, taking your medication will be as routine as, well, brushing your teeth. Enlist support from family and friends. Bring a trusted friend or family member to your appointments or to the pharmacy if you feel you may need help understanding or remembering medication instructions.
“When we judge people we have no time to love them.” - Mother Teresa
As the weather improves, there will likely be opportunities and obligations to spend time with family. We may look forward to being with some and may hold a reluctance to being with others. Here is an opportunity to work with that reluctance.
Instead of holding onto it, redirect it to a curiosity about the other. You may find you do not know much about that other. Formulate some questions you may wonder about and find an opportunity to ask those. Be aware of a possible new connection. If you stay in your reluctance, the opportunity to connect may be lost.
Recently I was in a situation with someone with whom I had always felt uncomfortable. I judged him to be surly and not interested in others. He was sitting by himself and I got curious about him. I approached him and asked if he was still living in his same home town. He opened up and I learned so much more about him. He was not surly and was actually interested in me as well. We were able to connect and the discomfort was gone.
One meaning of the word, Namaste is, “The light in me sees and honors the light in you.” I look forward to finding that light in others. When we feel our own light, it makes it easier to want to connect with another’s. Let’s connect with our own light and be curious about another’s. May you make bright connections throughout the whole new year.
Valerian root, or Valeriana officinalis, is an over-the-counter, herbal supplement that can be helpful for the treatment of insomnia, or difficulty sleeping. The use of this soothing herb for the treatment of insomnia dates back to the 2nd century.
The root of this plant is used to make an extract, which is then made into a tincture (liquid), capsule (pill) or herbal tea, all of which are forms that can be taken orally. Valerian root is a perennial plant native to Europe, Asia and naturalized in North America and is known for its savory or musky scent. Studies have shown that valerian root, taken within 1 to 3 hours of sleep, has been helpful for both the initiation and maintenance of sleep.
Valerian root is usually well tolerated and is less likely to cause morning drowsiness that is often associated with prescription medications used for the treatment of insomnia. Numerous pharmacological effects of Valeriana officinalis are mediated via modulation of the GABA system. GABA is a neurotransmitter in the brain which helps to decrease anxiety and relax, or slow down, brain activity in some areas of the brain.
Valerian root extract is classified as "generally regarded as safe" (GRAS) by the U.S. Food and Drug Administration and is approved as an effective, mild sedative by Germany's Commission E. However, as with any new supplement or medication, talk with your prescribing clinician before adding something new to your medication regimen.
TV, computers, phones, tablets, video games – social media, digital media, interactive media. . . Media is everywhere. A quick internet search provides a vast array of warnings about the risks of children using media along with guidelines specifying everything from when, where, and how to use media. Trying to sift through the ever increasing amount of data and opinions about what is “right” regarding media use for kids can leave parents feeling confused and overwhelmed.
While recommendations and guidelines for parents on how to use media responsibly have changed vastly over time, the overarching goals of parenting have remained the same – to provide for your child's physical and emotional needs while instilling and nurturing character and values to promote independence.
The American Academy of Pediatrics suggests making mindful decisions about media use by taking research and guidelines into account while asking yourself what the purpose of using media is for you and your child.
Examples of common questions parents may find themselves asking regarding media use for their child include:
Will handing my toddler a phone to watch a short video while I pay for groceries permanently stunt his/her development?
Mindful considerations: Research indicates that media use in young children may play a factor in delayed language skills; however, this is not likely to happen in the short time it takes to pay for groceries. If you find that you can't go to the grocery store without your toddler having a phone for the entire duration of the trip, it may be time to reconsider and create alternative solutions for your grocery shopping that would be more beneficial to nurturing a child's physical and emotional needs.
Is putting a TV in my child's room going to cause problems?
Mindful considerations: When purchasing a new TV, consider where the TV will be set up. Placing the TV in a common room and using it as a source of shared family entertainment can be beneficial in creating connectedness. However, placing a TV in a child's room is more likely to be detrimental to the child's sleep patterns. This also creates increased opportunity for isolation and is more difficult to monitor whether or not the child is choosing appropriate programming to watch.
Is allowing my child or teenager to use social media okay?
Mindful considerations: If social media is primarily used as a way to post funny pictures or easily plan group outings with friends, it can be beneficial to use. If using social media becomes a way to keep track of who said what about whom at school or becomes a source of comparison that results in your child having negative thoughts or feelings about him/herself, it is time to reconsider social media use.
As is true for most things, the use of media can be beneficial or harmful depending on how it is used. Parents can take this opportunity to educate and guide their children in ways that will promote healthy physical, emotional, and moral development. Have conversations with your kids about not talking to strangers in public or online, and teach your children to be honest and kind in their interactions with their peers in person and on social media.
Finally, DO feel empowered to set structure and rules for media use as well as consequences for misuse of media – just as you would about school attendance and homework, safety, and sleep.
Limited exposure to sunlight is not only helpful for people's mental health, but also for their body's physical health
What is Vitamin D?
Vitamin D is often called the “sunshine vitamin.” You can get Vitamin D from food or supplements, but exposure to the sun stimulates Vitamin D production in the skin.
Why is Vitamin D important?
Vitamin D serves several important functions in the body including: promoting calcium absorption, promoting bone health, and reducing inflammation. We also know that serotonin rises with exposure to bright light and falls with decreased sun exposure. Researchers estimate that 50 percent of the general population is at risk of Vitamin D deficiency. This percentage rises in higher-risk populations such as the elderly and those with darker skin.
How do you know if your Vitamin D level is in the right range?
We recommend testing every six months, as people vary widely in their response to UV exposure or oral Vitamin D supplementation. It is ideal to test in August (highest point) and again in February (lowest point).
How to supplement?
Recommended supplementation for Vitamin D is individualized. If one is unable to obtain limited exposure to sunlight, a vitamin supplement is helpful. A daily supplement of 2000 U daily may be enough for one person, while another may need to take up to 50,000 U per week to restore his/her level to normal.
Bipolar depression (depression that occurs after a history of one or more manic or hypomanic episodes) is treated differently that unipolar depression (depression that occurs without a history of manic or hypomanic episodes). Bipolar treatment guidelines used to recommend antidepressants as the first line treatment of bipolar depression until 2002 when the APA (American Psychiatric Association) changed their guidelines.
The change was due to studies and observational data that showed two concerns: antidepressants may not be effective in treating and preventing bipolar depression and may worsen the long-term course of the illness (cycling more often between depression and mania).
If you are diagnosed with bipolar disorder and on an antidepressant, there may be a reason for it. For example, a mood stabilizer did not work or you are taking it in combination with a mood stabilizer to help with residual bipolar depressive symptoms or due to a comorbid anxiety disorder.
Some common examples of mood stabilizers are lithium, lamotrigine, and valproic acid. Although these medications may have side effects, they should be considered at the core of any treatment regimen for bipolar disorder.
Jenny had been successfully managing the diet she started several weeks ago. Today was an unusually hectic day. With all of the stress she encountered, she was no longer able to resist temptation; her cravings got the better of her. She overate at dinner and continued to eat throughout the remainder of the evening. She was ashamed about what she had eaten and became highly critical of herself for her lack of willpower. She felt defeated and within days her old eating habits reemerged.
When it comes to unsuccessful efforts at habit change, Jenny is not alone. Every year, millions of people make New Year’s resolutions and in less than 60 days about 75% or these resolvers have resumed their old habits. Most cite lack of willpower as the barrier to their success.
The conventional belief about willpower is that it is a character trait that you either have or you don’t have. Willpower is not a character trait. Willpower could be more accurately defined as the effort needed to resist temptation and make positive change. This effort requires having the awareness and skills necessary to address a complex interaction between psychological, biological, situational forces. Habit change is then framed in the context of a process of change rather than just a goal to be achieved.
Motivation is a primary psychological component necessary to making behavioral change. This seems like a bit of a no-brainer, but motivation is complicated. We become motivated to change a habit for the better. But there is also a part of us that is motivated to stay the same. Thus, we are faced with competing motivations. The habits that we are trying to change have served a purpose in our lives.
For example, it might have provided a means of coping with stress or a source of pleasure and this habit has the advantage of offering immediate rewards or benefit. Conversely, the benefits of habit change are usually goals that usually are not going to be immediately realized and serve purposes not related to pleasure or coping with stress.
Old habits also have the advantage of being well rehearsed and can be set in motion with little or no thought. New habit behavior involves mindful effort, which requires considerable energy to successfully plan, execute, and maintain. Choosing between old habit behaviors versus new habit behaviors might be thought of as choosing between gently floating down the lazy river compared to swimming upstream against a heavy current.
As we go through our daily routines, there are environmental or internal cues that trigger habit behavior into action: a work break could be a cue for a cigarette or a snack; the beer vendor at a sporting event could trigger the desire for a drink; and the sight of scratch-off tickets in the gas station might prompt a return to gambling. Internal experiences such as boredom, loneliness, and at times even happiness also can influence the emergence of old habits. Often these cues are subtle and capable of automatically triggering behaviors before we even know we are engaged in it.
So how do we tilt the “willpower odds” in our favor? There are a number of strategies that can be adopted to greatly improve our chances for success.
It is important to learn to transform self-criticism into self-compassion. After Jenny overate, she proceeded to emotionally berate herself and in the process deflated her motivation to continue her weight loss plan. We are taught to be self-critical at an early age, to shame ourselves, and devalue ourselves when we make mistakes. It is commonly assumed that being self-critical is motivating.
If we punish ourselves, we’ll be more motivated to do the correct thing the next time. Research has consistently demonstrated that this is a harmful approach to habit change and that it will likely lead to failure. Self-criticism is emotionally hurtful and stressful. Our chances of resorting to old habits to cope with those feelings are greatly increased. A better approach will be to develop an attitude of self-accountability and mindfulness that begins with the recognition that successful habit change is a process.
There are going to be bumps in the road. When these temporary setbacks occur, they should be viewed as learning opportunities to first identify what went wrong and then to develop strategies to address similar “bumps” in the future.
Limit the number of major habit changes you plan to make to just one at a time. People who simultaneously choose to lose weight, exercise, give up smoking, and stop gambling, stretch their willpower resources too thin. This results in having little willpower reserve in the face of temptation. Choose to work on just one habit at a time. Stress and willpower can be competing forces for the body’s energy. Learning effective ways to develop resilience to stress can reduce its energy demands.
When these energy demands are lowered, more energy is available for willpower. Common strategies to deal with stress include: exercise, especially activities such as yoga or tai chi; getting sufficient rest; mindfulness meditation; spending time with friends and family; engaging in daily leisure activities that exclude television or video games; and spending daily time outside in nature. Even brief involvement in these activities when they are done consistently can have a significant impact on our ability to handle stress.
Having a better understanding of willpower and developing effective strategies to maintain it will greatly enhance your ability to change habits and achieve your goals.
Picking at your skin can be more disabling than the occasional mosquito bite. Some people suffer from picking at their scalp, blemishes, and bites to a point that can be disabling or disfiguring. Two illnesses in psychiatry suffer similar consequences - Excoriation Disorder and Trichotillomania (hair pulling disorder).
Various forms of treatment can be used to treat these conditions. Cognitive behavioral therapy is the most evidence-based treatment. This type of therapy is available online at ww2.stoppicking.com. This service is purchased for approximately $30 a month and helps patients achieve remission from nail biting, skin picking, lip chewing, etc. without medication. A similar online therapy is available for those with debilitating hair pulling (Trichotillomania) at ww2.stoppulling.com.
Sometimes, prescription medications like antidepressants and an over-the-counter supplement called N-acetyl-cysteine can be beneficial for treating these illnesses. Speak with your mental health provider if you think you are suffering from one of these illnesses to discuss what might be most helpful for you.
Excoriation disorder or otherwise known as, skin-picking disorder or dermatillomania, affects about 2% of the adult population over their lifetimes. It can be a bothersome disturbance which often occurs without full awareness of the one who does it. It is usually connected to some level of anxiety which is exacerbated by heightened levels of stress. Its habitual nature can lead to significant levels which may include picking which causes physical pain and can lead to scarring.
While most individuals are fairly open about this behavior if asked by a professional, many medical professionals do not ask in an intake session or do not explore the behavior fully. So the first tip in addressing this is to let your medical provider know if this behavior is a concern of yours.
Recommended therapy includes a combination of traditional cognitive therapy (replacement of irrational thoughts with rational), behavioral exposure and response prevention (acceptance of the feeling while changing the behavior).
Tips for Dealing with a Skin Picking Disorder:
1. Become aware of the amount of time spent skin picking
2. Become aware of events, thoughts or feelings which may result in picking.
3. Become aware of activities done in which skin picking does not occur.
4. Try to increase time in activities in which skin picking does not occur.
5. Learn relaxation techniques and practice them to develop a less anxious life style.
Talk to your healthcare provider, or therapist, about your problem. The staff at Providers For Healthy Living are available to answer any questions.
As prescribers at Providers for Healthy Living, we strive to practice evidence-based medicine (EBM). What is evidence-based medicine? EMB is the conscientious, explicit, judicious, and reasonable use of modern, best evidence in making decisions about the care of individual patients (1). This means that each time we evaluate a patient, we integrate our patient's wishes, our own clinical experience and expertise, and the best modern evidence before making a treatment recommendation.
Sometimes, this recommendation may include pharmacologic therapy (medication), and sometimes it may not. For example, current evidence suggests that pediatric patients with anxiety benefit from a 12-week course of Cognitive Behavioral Therapy (CBT) for anxiety prior to trying any medication.
Research also shows us that insomnia is often best treated with CBT for Insomnia rather than with medication. And, sometimes behavioral changes to correct unhelpful or harmful behaviors are necessary and we know medications won't make a difference, so we might recommend individual and/or family therapy to address the concerning behaviors. Should therapy interventions fail to provide relief of symptoms, we then will turn to possible pharmacologic options as a last resort.
In all cases, our goal is to find the best-fit treatment while using as little medication as possible.
REFERENCE - (1) Masic I, Miokavic M, Muhamedagic B. Evidence Based Medicine - New Approaches and Challenges. December 2008. Acta Inform Med.
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