Mental Health Monday–PTSD, A History

Last week, I discussed the symptoms of PTSD. Arlee Bird (writer and blogger–Tossing It Out) had a great follow up question.

When did the term PTSD come into regular use?

Lee is completely correct in recalling that the term “Post-Traumatic Stress Disorder” wasn’t coined until 1980 when the American Psychiatric Association added it to the Diagnostic and Statistical Manual III.

But “PTSD” has been around for far longer than 30 some odd years.

Heck, it probably goes back to the dawn of time!

Anyway…

In the Civil War, PTSD was known as “Soldier’s Heart.”

In World War I, PTSD was known as “Combat Fatigue” or “Shell Shock”

In World War II, PTSD was known as “Battle Fatigue” or “Gross Stress Reaction”

Unfortunately, prior to PTSD being called PTSD, it was thought the symptoms indicated cowardice or personal weakness.

It wasn’t until after the Vietnam War when people started taking notice. Called “Post-Vietnam Syndrome,” the new designation allowed Vietnam Veterans to push the medical and military to recognize it as a real disorder.

A big thanks to Psychiatric Disorders (d0t) com for this fascinating information!

Check out Lydia’s Medical Monday post and Sarah’s The Strangest Situation. Remember, these posts are for writing purposes ONLY and are NOT to be construed as medical advice or treatment.

Happy Writing!

Mental Health Monday–Drug-Induced Psychosis

Writer Colleen Rowan Kosinski asked about Substance-Induced Psychosis.

Here are the basics:

Drugs (legal and illegal) and even some herbal supplements when taken in excess can cause psychosis. Common offenders include alcohol, marijuana, cocaine, heroin, amphetamines (meth), and hallucinogens such as LSD and PCP. Prescribed medications such as prednisone, isoretinoin, scopolamine, L-dopa (used for Parkinson Disease), and anti-epileptics can also cause psychosis.

Substance-Induced Psychosis is something we see frequently in the inpatient psych unit and psychiatric ER (crisis unit). Obtaining a thorough history (from the patient and collateral sources) as well as getting a urine drug screen can identify which substances the person ingested. Some aren’t so easy to detect however.

New to the scene are synthetic marijuana (K2) and “spice” or “incense” (with mephedrone as the active ingredient). The psychosis caused by these substances tends to be more…intense. People can become severely psychotic, with paranoia, hallucintations, disorganized and fragmented thoughts, confusion, disorientation, and a tendency toward violence. Their symptoms are also less likely to respond to medications such as anti-psychotics. They end up spending a long time on the unit and don’t necessarily recover completely.

So what’s the best treatment for someone suffering from substance-induced psychosis?

  • Keep them safe (usually in the ER or on the psych unit)
  • Try to reduce stimuli as much as possible (dark, quiet rooms)
  • Provide structure (the same routine every day helps orient them)
  • Give anti-psychotic medication such as Haldol, Risperdal, Zyprexa, etc.
  • Use adjunctive medications to help with anxiety and withdrawal symptoms, if present; Clonidine, Motrin, Immodium, Benadryl, Ativan, etc.

Like Mr. Mackey from South Park says:

Drugs are bad, M’kay?

Just don’t do it! πŸ˜‰

DO check out Lydia’s Medical Monday post and Sarah’s The Strangest Situation!

Remember these posts are for writing purposes only and are NOT to be construed as medical advice of treatment.

Sisterhood of the Traveling Blog–Expectations

Sarah Fine (blogger of The Strangest Situation and writer repped by Kathleen Ortiz) asks:

Where do your expectations for your writing (career/skill/quality/achievements) come from? Is the source internal, external, or both? And how do you cope when you don’t meet them?

This question is SO pertinent to what I’ve been grappling with over the fall. Like, seriously.

When I first started writing, I did it for the sheer enjoyment. In the back of my mind, I mused about how cool it would be to see my work published, but I didn’t really think it was possible. As I continued to write, I noticed progression in my skill.

Then the craziest thought popped into my head:

I want to be published and I’m going to actually DO something about it!

Gosh, it would be grand to be the next JK Rowling or Stephen King. I also know that’s a looooooong shot. So, to be more realistic, I’d like to see my novels make it to print and I’d like to see a fair amount of people read them.

I do expect to hold a bound novel with my name on the cover. Others have expressed the same vision.

But it hasn’t happened yet.

And that leads to a LOT of frustration for me. So much so, that I contemplated quitting and didn’t write for several months. There’s a natural fallow time for every writer, but this time seemed to be…the end.

It looked like my way to cope was to finally face the “truth” that it wasn’t going to happen and give up.

I thought about that.

And thought about it.

And thought about it.

(I’m a shrink and a bit obsessive, so I thought about it a lot, okay?)

And thought about it.

Finally, I realized that I’d given away control. I’d let the industry dictate how I did things. I let it beat me down.

I’ve never done that before.

Then I remembered that everyone’s path to publication is unique. No way is right or wrong, better or worse, than any other.

For example, I started at a community college, then transfered to a four-year school before applying for medical school. I was rejected the first year (a not uncommon thing). I tried the next year and got in. Medical school was the hardest thing I’ve ever done. But I persevered. I got my MD. And I did it in an unconventional way. But it’s still an MD.

Publishing my work can be the same. I may not follow the path that most traditionally pubbed authors do. And that’s okay.

…I think I got off track a bit. Pretty normal, considering my general approach to life goals, LOL!

Bottom line, when in the writing game, I think it’s reasonable to expect the unexpected. Ha!

How about you? What are your expectations for writing and how do you handle it when it doesn’t work out the way you envision?

Stay tuned for Lydia’s response next week!

Happy New Year!

So, 2012 is here. If the Mayans are right, we only have a few months left to do whatever we plan to while on this planet.

The natural follow up to this is a discussion on goals. (Never mind that I’m not really buying the whole Doomsday in December thing.)

Last year, I wrote a list of writerly goals. I met about half of them. But I’m not disappointed, considering I had a huge change in my work responsibilities and I had a huge battle with my mojo over the past couple of months.

This year, I’m not going to write down goals. Why?

I don’t wanna.

Some may think that’s lame, but I don’t. I know what my overall goal is:

GET PUBLISHED.

BUT, I can’t put a timeline to that. All I can do is try my best every day. If that means slamming out 5000 words or doing absolutely nothing, that’s gonna have to be good enough.

Tell me folks, what’s your approach to goals?

Be sure to send me a writerly related psychiatric question so I can address it here on Mental Health Mondays. Check out Lydia’s Medical Monday (she’s talking about telekinesis today. Cool!!!) and Sarah Fine’s The Strangest Situation.

Cheers!

Mental Health Monday–Cold Turkey

Lynn Rush asks:

“What are the mental/behavioral side effects of opiate withdrawal? Any meds you’d recommend to help with it?”

Opioid withdrawal is a VERY painful process, BUT it’s not life threatening. (Those suffering from withdrawal often feel like they’re going to die, though!)

If you use some Lortab or Percocet for a few days after a surgery, you’re not likely to have symptoms of withdrawal when you stop. However, if you use any opioid (morphine, oxycodone, hydrocodone, dilaudid, heroin, etc) for weeks or months and you stop taking it suddenly, you’re likely to experience the following:

Early withdrawal:

Agitation
Anxiety
Muscle aches
Increased tearing
Insomnia
Runny nose
Sweating
Yawning

Later withdrawal:

Abdominal cramping
Diarrhea
Dilated pupils
Goose bumps
Nausea
Vomiting

Opioid withdrawal symptoms usually start within 12 hours of last heroin usage and within 30 hours of last methadone exposure.

Treatment of withdrawal usually includes the use of medications that combat the symptoms.

Clonindine–a blood pressure medicine that decreases anxiety, muscle aches, sweating, agitation, and cramps

Anti-diarrheal–to stop diarrhea

Anti-emetics–to stop nausea/vomiting

Fluids

Buprenorphine–a “partial agonist” that competes with opioids at the Mu receptor and is used for long term maintenance therapy for opioid dependence; a “high” is prevented if someone uses an opioid while taking this medication

Methadone–a long-acting opioid used for the treatment of opioid dependence; it does not produce a “high”, and reduces cravings to use

Remember, these posts are for writing purposes only and are NOT to be construed as medical treatment or advice.

Check out Lydia’s Medical Monday and Sarah’s The Strangest Situation!

(Non) Writer Wednesday

I’ve been seeing some Tweets lately of writers who have lost the mojo or motivation to write. Not that this is a new thing. It isn’t.

I mean, really, it’s impossible to churn out words and develop new ideas ALL THE TIME, right? Right.

So, is it okay to take time off?

Yes!

And if so, do you still consider yourself a writer?

Of course!

How do you fill your non-writerly time?

See below πŸ˜‰

 

When a Shiny New Idea strikes, I often obsessively work out characters, settings, plot twists, etc. I jot down notes, daydream about scenes, and often have wicked insomnia as I toss around dialogue in my head.

Cool.

Now, when Shiny New Idea becomes First Draft Manuscript (which occurs the moment I type THE END), I breathe a sigh of relief…

…and stare around the room like I have absolutely no idea what to do with myself.

And I consider the following…

Non-writerly Writer Activities:

  • Read
  • READ SOME MORE
  • Catch up on blog reading
  • Beta read/Critique
  • Spend time with friends/family
  • Shop
  • Outline Next Shiny New Idea
  • Revise old manuscript
  • Write something completely different, like a short story or flash fiction piece or poetry

What do youse guys do when you’re not writing?

Check out Lydia’s response to the Sisterhood of the Traveling Blog topic of “writerly edumacation!”

Sisterhood of the Traveling Blog–R U Edumacated?

Lydia asks the following question to the Traveling Blog Sisters:

“What formal writing experience do you have? (classes, degrees, major/minors). Did it shape your writing?Have you ever considered getting an MFA?”

My easy answer?

I’m not edumacated in the formal sense…well, I went to medical school, but that doesn’t really count because that’s where we doctors learn how to use abbreviations and develop our wretched handwriting skills. (Am I right, Lydia? Yeah. Admit it. I’m right. * snarf * )

And I took a basic English class in my freshman year of college. But other than that, no I’ve never taken creative writing classes or anything. Nor am I interested in getting an MFA. I’m done with homework. DONE. πŸ˜‰

Not that I’m against classes and such. I think that classes can be very good, even crucial to a writer’s development.

Tell me, friends, what classes, seminars, etc have you taken to develop your writing skill? What was helpful about it and why?

Stay tuned for next week, when Lydia answers her own question. πŸ˜‰

Mental Health Monday–Munchausen’s Syndrome

Lydia, Sarah, and I are converging to make the perfect storm trifecta of blog posts regarding Munchausen’s Syndrome.

Named after the great Baron von Munchausen, who purportedly told elaborate and fictional stories about himself, Munchausen’s Disorder is part of a class of disorders called Facticious Disorders.

The DSM-IV criteria for Facticious Disorders include:

  • Intentionally producing or feigning symptoms of a medical or mental illness
  • External motivators (as found in Malingering) (such as wanting three hots and a cot) are absent
  • Motivation for such behavior is to adapt the “sick role”

Munchausen Syndrome Factoids:

  • Individuals suffering from Munchausen Syndrome have a particularly chronic and severe course
  • They tend to have medical knowledge or even training in the medical field
  • They will intentionally infect themselves or overdose on medication such that medical intervention is necessary. Examples include: putting urine, feces, or dirty water in a wound; taking insulin to cause a drop in blood sugar; taking Warfarin (Coumadin), a blood thinner, to cause bruising and bleeding
  • They will often submit to or even demand invasive procedures and surgeries. A telltale sign of someone with Munchausen’s Syndrome is multiple scars over their bodies, particularly the abdomen
  • They will often move from town to town, hospital to hospital, especially when they are “found out”

The risks of having Munchausen’s Syndrome:

  • Feigning illness leads to unnecessary and sometimes risky procedures
  • Infecting a wound or overdosing on medications could be life-threatening
  • A patient often lies about real medical issues or allergies and therefore could be given treatment that will harm or even kill them
  • Because of multiple, unnecessary visits to hospitals, they are more at risk of developing iatrogenic illness
  • They often refuse corroboration with other treatment providers, leaving gaps in history that may be significant for a clinician to know

So, how do we help people with Munchausen’s Syndrome?

It’s VERY difficult. Most do not admit to their behavior and become very angry when confronted. They sign out AMA (Against Medical Advice) and seek another hospital/clinician. They are often not even remotely interested in psychiatric help. They have little insight (internal understanding) of their illness and behavior. In other words, they aren’t able to see what makes it risky or potentially harmful.

The individual in the photo below had over 40 unnecessary surgeries. Turns out, he did end up developing colon cancer. Talk about the case of the boy who cried wolf!

Remember, these posts are for WRITING PURPOSES ONLY and are NOT to be construed as medical or psychiatric treatment or advice.

ALSO, check out Kendall Grey’s blog today–I’m up for her Manual Transmission tour! πŸ™‚

We’re Halfway There!

Hey, gang, November is officially more than half over, which means Nanoers are heading toward the sloggy middle of their manuscripts!

For those of you who outline, you may have developed a nice plot line that’ll help guide you through the potential muck and slush of the-middle-of-the-novel, but those of you who are pansters may be stuck.

What’s a panster to do???

Well, here are some tips!

How to get un-stuck:

  • Skip a scene or three and write something that’ll get ya stoked about the story again.
  • Throw in a plot twist. (Didn’t know your character is allergic to peanuts? Have her hotter than hot love interest make her a peanut butter cup in the shape of a heart.) (The antagonist is actually the protagonist’s half-sister? Yikes!! Now what’re the characters gonna do?)
  • Free write using the POV of your main character. Just let them do the talking and see where it takes you. Inspiration may strike and you’ll be back on track again.
  • Remember Write or Die? Challenge yourself to a timed session there and I’ll guarantee you’ll be typing faster than your mind can think.
  • Sprint with some pals.
  • For God’s sake, take a freaking break and let your mind rest! Read a few chapters of the book you’ve set aside for the past two weeks. Go see Breaking Dawn. Let your unconscious (AKA subconscious) mind work things out. It’ll let you know when the problem is solved…Trust me. (You know those EUREKA! moments? That’s your unconscious giving you an answer.)
  • Take a walk. Physical exercise not only makes us healthier, it provides stress relief, and the scenery may just trigger an idea.
  • Check out Sarah’s Sisterhood of the Traveling Blog post on whether or not she Nanos. Then review Lydia’s and mine. πŸ˜‰
  • DON’T GIVE UP.

Your turn to share you ideas of how to get through the sloggy middle!

Mental Health Monday–Character Analysis: I Hear Voices…No, Really

Stina Lindenblatt asked me to give a run down of treatment for her character. He hears voices, but they are real (in a paranormal way). They end up driving him to cut his wrists. And Stina wants to know what would happen next.

In the state of New York (where I live), someone can be admitted to a psychiatric facility on an Emergency Admission. Also known as an Involuntary admission, people who are a danger to themselves or others can be admitted for treatment, even if they don’t want to be. (We also admit people voluntarily, of course.) I bring this up because not all states have this law.

So, if Stina’s character showed up in my ER, let’s say, and has cut his wrists and reports hearing voices, I’d recommend inpatient hospitalization for his safety and stabilization. Treatment would include keeping him in a safe environment (in the hospital), offering him medication, individualized therapy, and group programming.

Medication varies by diagnosis and symptoms, but someone experiencing auditory hallucinations (voices) would be given an anti-psychotic. “First-generation anti-psychotics” (so called because they were identified and produced first) include Haldol, Thorazine, and Prolixin. They are fast and effective, and though Stina’s character would likely be sleepy for the first few days he’s on them, he’d also note resolution of symptoms within a few days to a couple of weeks. “Second=generation anti-psychotics” (so called because they were developed after the first generation ones and were touted to have less side effects (despite causing other side effects like metabolic changes)) include Risperdal, Seroquel, Zyprexa, and Abilify. Also quick-acting, these agents would resolve Stina’s character’s symptoms within a few days.

One may assume cutting of wrists indicates a suicide attempt and therefore means the person is depressed. (This isn’t always the case, but let’s go with that assumption here, okay?) So, in addition to the antipsychotic, Stina’s character would be offered an anti-depressant like Zoloft, Prozac, Celexa, Wellbutrin, or Effexor. These medications take several weeks to kick in. A person doesn’t have to stay in the hospital for that length of time, by any means. We just need to see their mood begin to stabilize out.

Before leaving the hospital, it would be important for Stina’s character to have follow up treatment with a psychiatrist and counselor scheduled. This would allow for outpatient monitoring of his medications and symptoms. Antipsychotics (if symptoms are resolved and thought to be part of a depressive episode) can be discontinued within a few weeks or months. Anti-depressants should be taken for at least a year to fully treat the current episode and prevent future ones.

If someone has chronic symptoms and history of depressive episodes, they’d more than likely need to stay on medications long-term. If someone has chronic psychosis, they’d need to stay on the medications long-term as well.

Stina’s character is 17, which may alter his management a bit…however, in this case, he’d likely be given the same medications as an adult.

Based on Stina’s description of her character’s clinical presentation, I’d diagnose him with Psychotic Disorder Not Otherwise Specified (he doesn’t necessarily meet criteria for DSM-IV diagnosis) and perhaps Depressive Disorder Not Otherwise Specified.

Other potential diagnoses include: Brief Psychotic Episode, Schizophreniform Disorder, Schizophrenia, Schizoaffective Disorder, and Major Depressive Disorder with Psychotic Features. Any medical conditions or drug use would have to be considered as well.

I hope this is helpful, Stina!

I’d be happy to answer any follow up questions as well. There’s a lot of information in this post and I could certainly go on, but I won’t cause your eyes will start crossing soon. πŸ˜‰

Be sure to check out Lydia’s Medical Monday post about what plant in your garden could kill you.

Remember, these posts are for WRITING PURPOSES ONLY and are NOT to be construed as medical treatment or advice. Happy writing!