Monday, September 22, 2008

September 2008 PSYCHOPHARMACOLOGY UPDATE Volume 8 No 9


NEUROPSYCHIATRIC ASPECTS OF ANXIETY DISORDERS

Recent research advances allow neurochemical hypotheses for each of the different anxiety disorders.

Generalized Anxiety Disorder

Ø    Neurochemical abnormalities

o      Suppressed serotonergic mediation

§       SSRIs increase serotonin

o      Decrease in GABA, the brain’s predominant inhibitory neurotransmitter

§       Benzodiazepines improve GABA effects

§       Depakote increases GABA concentrations

o      Activation of the locus coeruleus-norepinephrine-sympathetic system

§       Effexor modulates

Obsessive-Compulsive Disorder = the tenth most disabling of all medical conditions worldwide

Ø    Increased activity in the ventromedial-cortico-striatal-thalamic-cortical circuit

Ø    Neurochemical abnormalities

o      Region specific serotonergic abnormality

§       Only 50% of OCD patients respond to SSRIs alone

o      Abnormal dopamine striatal circuits

§       Augment SSRIs with antipsychotics

o      Decreased GABA and increased glutamate

§       Add Depakote (calms by increasing GABA) and/or Lamictal (calms by suppressing glutamate)

Panic Disorder

Ø    The amygdala plays a central role in conditioned fear sending out efferents to:

o      The lateral nucleus of the amygdala—autonomic arousal

o      Hypothalamus —increases adrenocorticoid release

o      Locus coeruleus—increases norepinephrine release

o      Parabrachial nucleus—increases respiratory rate

Ø    Treatment—there is no integrated treatment for the neurochemical complexity of panic. Currently the treatment for panic remains SSRIs and benzodiazepines

Posttraumatic Stress Disorder

Ø   The amygdala and limbic regions play a particularly important role in the final common pathway of chronic hypersensitivity to post traumatic events

Ø   The hypothalamic-pituitary-adrenal system results in decreased cortisol and increased glucocorticoid receptor responsiveness found in chronic stress and in neuronal damage of  the hippocampus that could account for some of the cognitive impairments found in PTSD

Ø   Treatment—multiple medication combinations can help relieve specific symptom complexes

 

October 1, 2008 I will begin a position at Carilion New River Valley Medical Center, Virginia. You can find Psychopharmacology Update on the Blog, Relationship Solutions: LifeWorks or you can receive a hard copy by sending $12 to cover printing/postage for one year to Wende Whitus, 2820 Huckleberry Hill Dr, Fort Mill, SC 29715. 

www.glenstonechapel.org

Saturday, September 20, 2008

Listen to Sermon by Greg Whitus

http://www.glenstonechapel.org/sermon/rebel-with-a-cause/

Friday, September 19, 2008

The Waiting Place

LifeWorks            Volume 12 No 9                                    September 2008


When you are getting ready to move time passes with the gush and ripple of a snow-fed mountain stream. It was like that for him as summer passed and the days shortened. Like an ageless schoolboy, he still measured time in sequential fashion, by use of clocks and calendars, by the passing seasons and the sports they brought. There was basketball in the winter, tennis in the spring, baseball in summer, and football in the fall. But with letters to write, notices to post, charts to duplicate, forms to complete, property to lease, furniture to pack, work to complete, and farewells to bid, there was no schedule for him this fall. The press of the move brought unexpected blessings—there was no time to grieve the pain of departing and those friends soon departed.

He had come here October 1, 2000 to take a position no one else wanted. He was the only psychiatrist on a ten-bed unit in a rural hospital. This unit, considered inconsequential to academic centers, serviced an area bordered by Houston to the south, Austin-Temple to the west, Waco to the north, and Lufkin to the east.

He worked seven days a week, Monday through Sunday. Everywhere he went he carried a cell phone. Calls for his services came throughout the day and night. After 343 days, he persuaded the administrator to find a locum tenens doctor to give him a break for a few days. When the hospital bureaucracy realized that no one else would work such onerous hours, the administrators became a little kinder and gave him a few more days off each year.

For the first time in his life, he sensed that he was filling a void that few in his profession would consider worthy of their efforts. He felt blessed by a wonderful staff—Jeff Baker, Susan Bice, Felicia Carmouche, Jan Childress, Barbara Courser, Sharon Davila, Shirley Higginbotham, Carroll Johnson, Kelly Kyle, Donna Patterson-Paddock, Liz Peterson, Carol Davis-Rios, Norma Rivas, Lyne’ Taylor, Brigitte Turner, and Stephanie Quintanilla—all took pleasure in helping each other help others. The administrator, Michelle Comeaux, who made certain that the unit received the highest praise from the Joint Commission and other hospital inspectors by precise dedication to bureaucratic rules and regulations, epitomized the staff’s diligence.

They were an informal and loving group who put patient care first, helped each other be the best they could, and had fun working together. Almost all the staff had a strong non-judgmental Christian faith. While they respected other religious faiths and those with no spiritual beliefs, they felt unreluctant to pray for and with their patients.

Mornings were spent in staffing. He would sit at the head of the conference table, the social worker to his left, and the nurse across from him. The patient would sit on his right. The patient’s case would be reviewed each day. Suggestions for therapy were completed and medication adjusted. Many times family members of the patient joined the group.

He felt confident with the nurses and clinicians, because each had the knowledge and assurance to suggest approaches to treatment and changes in procedure. They all recognized nuances in human behavior. The night nurses, those lonely, loyal warriors who had the awesome responsibility of protecting the patients’ health while the day staff enjoyed home and hearth, received the highest respect. The skill of the staff persuaded him to remain year after year despite the pull toward family and beautiful vistas.           

Neighbors and friends provided consolation for family separation. God and her church comforted his wife. Bible study groups and the renewal of the church vows to uphold worship with “prayers, presence, gifts, service, and witness” sustained her. She received special joy from the choir and their music. The warmth of friends that seemed irreplaceable kept them rooted to a spot they considered impermanent.

This staying thing was odd. He and his wife wanted to return to the Mid-Atlantic States to be closer to their family. The pull toward their children made sense. Staying at a provincial hospital didn’t. He interviewed at several eastern medical centers, but couldn’t find a hospital—large or small—in the Carolinas that satisfied him.           

Ambivalence overpowered him. Each time he was on the verge of moving, he remembered his staff, his friends, and his church, and stayed. Eight years after he had come to this rural hospital, he could look back upon his experiences with a deep and sumptuous tranquility blemished by a reluctant conscience to return to a cool and verdant land.           

He sat in his front parlor on a Sunday afternoon. It was cold and foggy that February afternoon and he had no desire to go out. A light drizzle penetrated the air. He had not felt too well since he played tennis with his son during the Christmas holidays. He fancied that the clock ticking in the kitchen, tolled for him.

The thought of his children wrapped a cold vapor around his heart. He could no longer tolerate his selfishness at keeping his wife from her loved ones. She brought him a cup of tea. “Please sit with me for a while, he said. “I want to read you something.”

You’re off to Great Places! You’re off and away!

You have brains in your head. 
You have feet in your shoes.


You can steer yourself 
any direction you choose. 


Do you dare to stay out? Do you dare to go in? 


How much can you lose? How much can you win? 



Simple it’s not, I’m afraid you will find, 
for a mind-maker-upper to make up his mind. 


You can get so confused
 that you’ll start in to race
 down long wiggled roads at a break-

necking pace
 and grind on for miles across weirdish wild space, 
headed, I fear, toward

a most useless place. 


The Waiting Place…for people just waiting. 


Waiting for a train to go 
or a bus to come, or a plane to go
 or the mail to come, or

the rain to pour or the phone to ring, or the snow to snow
.

You’ll escape
 all that waiting and staying.

You’ll find the bright places
 where Boom Bands are playing

There is fun to be done! 
There are points to be scored.

There are games to be won. 
 
Today is your day! Your mountain is waiting. 
 

Outside the drizzle had stopped. The setting sun gave the sky a pink luminescence. Raindrops dripped off  the philodendron. She sat very still looking at far away places. “We’re moving back home to the kids, aren’t we?”

 



Thursday, September 18, 2008

Time's Friend


What a friend we have in time--gives us children, makes us wine, tells us what to take or leave behind. Friends I will remember you, think of you, pray for you, and when another day is through I'll still be friends with you.

 

Tuesday, September 16, 2008

In Times of Distress

Remember, in times of economic distress, keep your cool and be thankful for your blessings--good health, good friends, and supportive family.

Monday, September 15, 2008

A Checklist for Doctors Moving Their Medical Practice

A friend is moving his Medical practice from one state to another. He was amazed at the requirements for making a move. He has to:

  1. Notify his patients that he has seen in the past two years by letter that he is changing his practice
  2. Notify the Texas Medical Board 
  3. Publish a notice in the newspaper of the greatest general circulation in each county in which the physician practices
  4. Place a written notice in his office
  5. Notify the DEA
  6. Notify the Texas Department of Public Safety
  7. Notify Medicare
  8. Notify Medicaid
  9. Notify Champus
  10. Provide medical records to physicians/and or the patient

 


Sunday, September 14, 2008

No Water, No Electricity

Hurricane Ike felled three giant oaks in my 80-year-old uncle's yard. One oak punched a hole in his roof, right over his bedroom. With the wind blowing 50-70 knots and the rain falling, he climbed on the roof, cut the limb off the tree trunk, pushed the limb off the roof, and secured plastic over the hole. He let no one know he was having difficulty. When he couldn't be reached by phone, I drove out to his place. He had no electricity, two full one-liter water bottles , a gallon jug of potable water, and a barrel of water for flushing the commode. His meat, milk, and other refrigerated food were spoiled. He and his 85-year-old wife refused to come home with me. They will be out of electricity for a week or more, probably.

Saturday, September 13, 2008

The Moon Shines on Everyone

On September 12, 2008 the moon was three days from being full. People somewhere would look up at the darkened sky and say "What a beautiful moon." Within a 500 mile radius of Galveston and Houston, no one saw the moon. A Hurricane cloud was in the way. Hurricane Ike made extensive damage to the Island and to Houston and west of the eye that passed through Madisonville, Huntsville, and Lufkin leaving very little damage in its wake in College Station, Texas. The wind blew hard enough to blow a portion of our fence down. A small 15' pine was felled. Four shingles blew off our ridge line. Electricity and our generator was down in our little hospital in Grimes county so our four patients were moved to the Rehab unit in Bryan, but that was the extent of our personal damage. Next time I will look at the moon with a different perspective: "What's happening to those people who live 500 miles away from me who are looking at the same moon?"


Thursday, September 11, 2008

Hopeful Words

I think the American economy will recover and go on to another bubble of some kind BUT---maybe, just maybe, we can take a lesson from this particular bubble to try and reduce the severity of the next one.  We have GOT to do something to reduce Congressional meddling in the free markets.  Many on the left-leaning side of the aisle are attempting to lay this 'crisis' at the feet of George Bush (for obvious political reasons) while I would lay it at the feet of Congress. 
Howard Talley

Wednesday, September 10, 2008

The Insomniac Millionaire

Twenty years ago he couldn't sleep so he watched late night infomercials and bought some tapes for $39.95. He followed the plan, gradually buying property. Now he owns 30 houses in Colorado and 70 in South Carolina. He likes to sell his properties to people who had a few lucky years. When they are flush with cash, they buy a mountain villa or a seaside cottage. In a few years they can't make their payments. He gets his property back and sells it to another "lucky" person.

He says housing will continue to deflate for another 10-12 months. Lyle Fischer says to put an add in the classifieds--Want to Buy Land. There are, he says, hundreds of "lucky" people lying awake at night wondering how they are going to get rid of the property they purchased during the flush times. They will answer the call to that add (264-5383). 

Tuesday, September 9, 2008

TIME TO SAY GOODBYE

When I'm alone
 I dream of the horizon
 and words fail

I know there is no light in a room where the sun is absent, 


If you are not here with me. 


I'll go with you 
to countries I never
 saw and shared with you. 


I shall experience them. 


When you are far away 
I dream of the horizon 
and words fail. 


And, yes, I know 
that you are with me; 


You, my moon, are here with me

My sun, you are here with me


Time to say goodbye.

Monday, September 8, 2008

Children Get Older Too

With my love walked up valleys and down

Climbed a mountain and turned around

Saw my reflection in sun shining souls

The heart’s joy brought me down

Reflections in the eye

Where is love?

Can the child in my heart go with the ride?

Can I sail thru the changing ocean tide?

Can I handle the seasons rearranging?

Well, I’ve been afraid of changing

Cause I’ve built my life around you

But time makes you bolder

Children get older

I’m getting older too.

Take my love, send it around

Climb a mountain and turn back down

If you see my reflection in sun shining souls

May the new destinations make it shine on?

If you see my reflection in sun shining souls

May the new directions make it shine on?



Friday, September 5, 2008

Skip the Complaints

 The paper work this move requires has been incredible. First, I had reams of paperwork to complete and thousands of telephone calls to make to get my Virginia license.

 Then Carilion called to ask for the same material plus 584 more pages to complete for their credentialing. And they called back and wanted a fax number of every place I have ever worked including Internship and Air Force. They have another huge form for me to complete for physical illness and promotion material. And then they sent 18,999 documents for me to sign so they could get the insurance money I make for them.

 (Does working for someone take away incentive? ----not for me because I am in this business to help others, but I can see how giving the profits to someone else while you do all the work can be deflating, especially when a lot of unnecessary paperwork is required for each procedure.)

 They there are all of the changes in rules and regulations at Carilion and a huge staff and dozens of psychiatrist I will need to monitor and help. I'm afraid the new job will flood me with long, frustrating work with much less pay. When I was younger, I thrived on new challenges. Now I don't know if I have maintained the energy I once possessed.

 And most disconcerting, is loss of our church home, our many true, trustworthy, and fun friends, my mother, and Craig, my incredible staff.

 I’m developing stress symptoms---I’m not sleeping well. I am losing my temper over insignificant things, not reading my Bible, not praying daily, not reading books, not exercising.

 I wished I had invested my money more wisely. If I had taken the advise of just two people and if I had gradually added money to two of the investments they recommended and not sold them prematurely, I would be a multi, multi, multi millionaire so I wouldn’t have to work until I am 70+.

 I’m having a pity party when there are billions in the world who are starving and being tortured with each passing minute. And just think--When I get to the pearly gates St. Peter can pull this information off the Internet and show me what an ingrate I have been.

 One thing that sustains me is you, Wende, --you are the darling of my heart and a special child of God---loving, loyal, understanding, forgiving, encouraging, consistent, a unique individual to whom God has given the full quotient of 10 talents. And then there is supporting, encouraging, consistent, loyal, and inside-and-out beautiful Vicki who has sustained me through good and bad times. And Lori and Lindsey, sweet little girls, and Greg who is just about becoming my best male friend. And Brad my amazingly talented, ebullient, and funny son...Andrea...Alex.... Annie...my mother...and of course Jesus and the Holy Spirit. When I think of all of you, the paper work and challenges of a new job become a little mosquito.

 I will say this, however: After Jesus had been in the desert for 40 days and the Devil had given Jesus 67,125 papers to complete before he could work with God, Jesus may have joined the Devil's team.

Thursday, September 4, 2008

Defeated

Brad beat me in tennis today 7-5, 6-2, 7-6. He was playing exceptionally well. He kept me off balance all day with a powerful serve, aggressiveness at the net, and hitting winners on all but two overheads, most of which were difficult to return. He also played with patience and then used powerful ground strokes to throw off my timing. His drop shot had me on the defensive. Yet, I had my chances and used the most abominable strategy of playing not to lose instead of playing to win. This defensive approach was forced by Brad's aggressiveness and my poor serving day. Nonetheless, Brad won fairly and squarely dominating me more than the score would indicate. The alarming question that arises with each new day is this: Will I ever beat Brad again. He is strong, fast, quick, and physically fit. Biology indicates that I can expect to lose strength, quickness, and speed with each passing day. I hope that for a few more months, I can at least keep our matches competitive.

In the afternoon made a few phone calls regarding land in Virginia. I also called a home builder to get some ideas on square footage cost.

Wednesday, September 3, 2008

Alex and Annie the First Generation Under the Tyranny of Socialism

Alex is all boy and Annie and beautiful girl. Had fun holding Annie and reading to Alex and playing tennis, getting his hand-held motor shooter in the mud. Against Brad, I won the first set 6-4 and he won the second 6-4. 
Watched a movie filled with debauchery, The Dewey Cox Story, but James T. Riley can certainly sing. The movie would have been much better if they just let him sing. 
Later Brad and I watched Governor Palin. We were both impressed.
Then we watched Obama's video and his speech. I did well telling Brad all the things I liked about Obama and leaving out the he is a socialist and possibly communist with hatred for the American Independent way of life. He wants the government to do everything for each American as he has no faith in the common man because he was mentored by anarchists.  But, of course, I said nothing about this. Instead I occasional yelled "I back Barrack" and "Mamma's for Obamas." You can't win an argument, so why not have a little fun.
Despite Governor Palin's strong showing, I fear that the Democrats will entice us into their web of socialism. This year is the last of America as I have known it. I will not have to suffer socialism.  I will die in the next decade or two and by the time clear thinking American's wake up it will be too late. Oh well, the law of entropy and greed eventually causes all empires to fail.
As an aside I heard a woman Democrat radio host compare Palin the the porno movie star who comes to the door with her glasses on and after letting the Fuller Brush salesman in the house, unties her hair, takes off her glasses, and shows the salesmen creative uses for the Fuller Brush.

Tuesday, September 2, 2008

The Drive to Wilmington.

The drive from Blacksburg to Wilmington is 564 miles, but it is freeway all the way and takes a tad under six hours. fabulous 4-5 lanes in most of North Carolina. Beat Brad 6-4 and 6-3 in tennis as he attempted to slug his way to victory.

Monday, September 1, 2008

Family and Land

Looked for land with Nancy. Found a beautiful 6.99 acre lot close to Blacksburg owned by Mr. Jack Chin Juang, but cost is prohibitive. Lunch with family and then a drive Cascade Falls before the kids left for Charlotte.