Monthly Archives: April 2014

Report: Proper SSRI Antidepressant Starting Dose Minimizes Suicide Risk In Young Adults

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     A large, well-controlled pharmacoepidemiological study shows that three SSRI antidepressants do not increase suicide risk in 10- to 24-year-olds when given at the proper, recommended doses. Higher doses were associated with a 2.2-fold increase in suicide risk. No similar dose effect was seen in those age 25 to 64.   read »

From Forbes.com, the blog of David Kroll, a pharma expert who used to blog for PLOS Blogs, my current employer. I recommend you to read on!

More Americans Understand Mental Illness; Climate Change, Vaccines or the Big Bang…Not So Much

08klass-articleinlineI think my regular readers will find this new poll as interesting as I do! In the table below check out the results of a recent AP survey looking into the confidence Americans have in various concepts which are considered “accepted science.” And while I’m worried by the findings that 51% of those polled don’t think our world started with a Big Bang, and only 53% have confidence in vaccine effectiveness and safety, I find other numbers surprising and even encouraging. For example, 61%, nearly 2/3, are either very or fairly confident that the earth is warming due to human activities. Okay, better than I might have expected. But best of all… 71% say they are extremely or very confident that “a mental illness is a medical condition that affects the brain”.  Another 12% are somewhat confident of this fact, adding up to a whopping 92% who lean favorably towards a scientific understanding of mental disorders. When one considers how much stigma has been driven by an absence of this understanding, we have to be encouraged that things are indeed changing. But then, I am an optimist by nature. What are your thoughts on these questions and answers?

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A Psychiatrist Diagnoses “House of Cards” — Is Claire Underwood a Narcissist?

claire-underwood-blood-300x300I’m sharing the latest blog post from Stanford psychiatrist Shaili Jain, who uses  House of Cards husband and wife team, Frank and Claire Underwood (aka Kevin Spacey and Robin Wright) to teach us about some little understood psychological diagnoses. Here, in its entirety, from “Mind the Brain” on PLOS Blogs Network.

By Shaili Jain, MD

Last month I used the character of Frank Underwood as a “case study” to illustrate the misunderstood psychiatric diagnosis of Antisocial Personality Disorder, and many of you asked: Well, what about his wife, Claire? Good question!  You asked, and so today I will do my best to  answer.
SPOILER ALERT: For those of you who have not been on a streaming binge and watched all of Season 2 yet, consider yourself warned. 
Image: Netflix
Clinical lore would certainly support that Claire, herself, must have a personality disorder of some kind – a sort of fatal attraction, where a couple is drawn to each other because there is something in their personality patterns which is complementary and reciprocal. She does appear to have mastered the art of turning a blind eye to Frank’s more antisocial exploits.  She is a highly intelligent woman, and she must have some inkling that her husband may be involved in the death of Zoe Barnes and Peter Russo.  But if she has an inkling, she does not show it.
Claire, from what we know, does not engage in outright antisocial behavior.  Unlike Frank, she has not murdered anyone and we have not seen her engage in very reckless or impulsive outbursts. However, she rarely shows emotion—her smiles seem fake, her laugh empty, and her expressions are bland.  She is more restrained and guarded than Frank, and she does not reveal her inner thoughts to the viewer the way Frank does so it is much harder to know what could be going on in her mind. Still, I think I have seen enough to venture forth with an assertion that she may have a Narcissistic Personality Disorder.
What is Narcissistic Personality Disorder?

A pervasive pattern of grandiosity, need for admiration, and lack of empathy beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of 9 criteria.

Below are the five criteria that I think apply to Claire:

1) Has a sense of entitlement (i.e. unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations) 

 

  Image: NetflixShe expected Galloway to take the blame for the photos that were leaked and eventually claim it was all a “publicity stunt,” thus ruining his own reputation and image.  She expressed no regret that her ex-lover was cornered into having to do this, on her behalf, and no remorse that it almost ruined his life and his relationship with his fiancé. She was entitled to this act because she is “special” and expects that people will “fall on their swords” for her.

2) Is interpersonally exploitative (i.e. takes advantage of others to achieve his or her own ends)

  Claire manipulates the first lady, Tricia Walker, into believing Christina (a White House aide) is interested in the president. She pretends to be a friend, wangles her way into becoming the first lady’s confidant, and persuades her to enter couples therapy with the president.  All of this is actually part of an elaborate plan to help Frank take the President down so that he can become president and she (Claire) can usurp Tricia as first lady. Another example: Claire is pressured by the media into revealing that she once had an abortion, but she lies and states that the unborn child was a result of rape (presumably to save political face).  Again, she shows no remorse about her lie and instead profits from it, gaining much sympathy and public support.

3) Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others

This was best seen in the way Claire deals with her former employee Gillian Cole’s threat of a lawsuit –  she pulls a few strings and threatens the life of Gillian’s unborn baby.  In fact, in addition to the obvious lack of empathy was the simmering rage she had toward Gillian for daring to cross her.  Again, entitlement, narcissistic rage, and a lack of empathy would explain that evil threat she made, to Gillian’s face, about the baby.

4) Is often envious of others or believes that others are envious of him or her

I think part of the reason Claire was so angry at Gillian was because, deep down, she was envious of her pregnancy.  We know that, in parallel, Claire is consulting a doctor about becoming pregnant and is told that her chances are slim.  This is such a narcissistic injury to Claire that she directs her rage at Gillian.  I don’t think she was even consciously aware of how envious she is of Gillian for being pregnant. Another example would be the look on her face when Galloway indicates he is madly in love with his fiancé and wishes to make a life with her.  For a second her face darkens – a flash of jealous rage – which then translates to indifference and almost pleasure at his eventual public humiliation.

5) Shows arrogant, haughty behaviors or attitudes 

Image: Netflix

Correct me if I am wrong, but Claire just does not appear to be that warm or genuine and has an almost untouchable air about her. Furthermore, we only ever see her with people who work for her (i.e. have less power than her) or with people more powerful than her (i.e. whose power she wants for herself). Other than Frank, where are her equals? Her oldest friends and colleagues? Her family? People who might not be influenced by her title or power?

One last comment – in Season 2 Claire certainly comes across as more ruthless and power hungry than the Claire in Season 1—whether she is now showing her true colors and is dropping her facade or just becoming more lost in Frank’s world and hence looking more like him is unclear to me… I suppose we will find out in Season 3!

Meanwhile, if you want to read Shaili’s diagnosis of Frank Underwood, go here.

Creative Commons License This work, unless otherwise expressly stated, is licensed under aCreative Commons Attribution 3.0 Unported License.

Becoming a Digital Media Sensation, While Struggling with Depression — a wise and touching post by Jennifer Pastiloff

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“I’ve carved out a beautiful life and love what I do, but sometimes, especially lately, I feel the old tug of depression, that magnet of sadness which is buried somewhere next to the grief of losing my father at such a young age, but not relegated to that grief. “

This poignant line comes from an article I’d like to recommend by  She’s a young yoga teacher, inspirational speaker, and a digital media sensation (pictured above), who writes about her battle with depression, and how she’s making tough choices like staying on or getting off antidepressants (for her pregnancy and then after) and how (or even if) she can deal openly with her depression with her friends and many fans.  I’ve pasted another favorite piece of her post below followed by a link to the full post on xo jane…

“About a year after I had gone on anti-depressants, I quit the restaurant. I started leading inspirational workshops, which quickly turned into sold-out workshops and retreats all over the world. I developed this huge online following. It all happened very quickly — I went from career waitress to traveling around the world and being on Good Morning America and featured in New York Magazine. And all this success came while I was on meds.

I felt like a fraud. I felt like I should be able to use the tools I was teaching in my workshops and not have to be on anti-depressants. So I went off last summer, and about five minutes later got pregnant….” read the full post here:
 
 
 
 

New analysis of international suicide data repeats 10 year old finding; 85% suffer from a mental illness

Almost startling in its consistency, a new peer-reviewed study published in PLOS ONE (April 2, 2014) , a full decade after the often-cited McGill University metastudy on the relationship between mental illness and suicide risk, produced essentially the same major finding —  within 2%. The Australian and American scientists responsible for the new research paper, titled The Burden Attributable to Mental and Substance Use Disorders as Risk Factors for Suicide: Findings from the Global Burden of Disease Study 2010, compiled worldwide data from the World Health Organization (WHO) to show that 85% of people who die by suicide have a debilitating mental disorder. One difference: this study includes addiction as a major mental disorder, which reflects more recent classifications in the mental health field.

The underlying WHO data doesn’t fully represent mid to lower income countries so even this high a percentage linking suicide and mental illness no doubt underestimates the real numbers of people who die by their own hand in places where national and local health systems simply don’t count them. For better or worse, this research certainly covers most of us living in the US.

Sometimes the numbers provide important nuances to help us understand who, how, where, when and even why…

  • Nearly 1 million people complete suicide every year with over 50% aged between 15 and 44 years [14][15].
  • Over 80% of suicides occur in low to middle income countries and close to 50% occur in India and China alone [15][16].
  • the risk of suicide was 7.5 (6.2–9.0) times higher in males and 11.7 (9.7–14.1) times higher in females with a mental or substance use disorder compared to males and females with no mental health or addiction disorder
  • Suicide from firearms, car exhaust and poisoning are more common in high income countries and suicide from pesticide poisoning, hanging and self-immolation are more common in low to middle income countries [17].

There is also a telling graph of which disorders rank as the most and least dangerous in terms of suicide risk, with major depression leading the way: journal.pone.0091936.g004 Lastly, the authors also looked at prevention strategies, and found that equipping general practitioners to diagnose and treat major depression had the highest value as a strategy, with a few caveats, as usual having to do with the quality of care. ” This was one of the few interventions for which there was good evidence of effectiveness as a suicide prevention strategy in a recent review by Mann and colleagues. That said, ensuring that care from general practitioners is evidence-based requires further consideration, given findings that rates of minimally adequate treatment for depression are lower among patients treated solely by general practitioners or in the general medical care sector, compared to those treated by specialist mental health providers.”

The unavoidable point: treatable mental disorders if left untreated put you at a much higher risk for suicide. What else is there to say?