New lower price for Psychiatry in Techno Colors

Happy New Year.  May you new year be filled with health and happiness. 
Take advantage of new lower sale price for paperback edition.
buy Psychiatry in Techno Colors at discounted price.

Next book signing at the Big E, West Springfield in the Connecticut Building

Meet the Author

Psychiatry in Techno Colors: a psychiatrist’s memoir of lessons learned about the diagnosis and treatment of anxiety and depression is a collection of easy to read essays which explain the life of a psychiatrist and the medications available to help those with anxiety and depression. Anyone who knows someone with depression or anxiety can benefit greatly by his lifetime experiences with patients. It is easy to read and once you start reading it, you can't put it down.  The author, Neil Liebowitz, MD is the director of the Connecticut Anxiety & Depression Treatment Center in Farmington, CT and will be signing his book at the Connecticut Building at the Big E on Saturday September 24^th from 4 to 7pm and Tuesday September 27^th  from 7 to 9pm.

The science and joy of anything goes bread

The science and joy of anything goes bread

            I was inspired by Barbara, of http://barbswritingsandrecipes.blogspot.com to share my special recipe for anything goes bread.  I am a person who doesn’t like to waste anything.  I also like to make and eat healthy bread made with whole grains, lots of fiber and other good stuff.  Several years ago my wife bought me a bread maker and I experimented with a variety of the recipes that came with the maker.  Most were traditional breads that relied heavily on white flours.  When I tried to make breads without the white flour I often got a charred lump of barely risen flour.  Through experimentation and studying the science of bread making I came upon the formula that allowed me to put almost anything in my bread.

            There is a science to making yeast breads.  Yeast is a living single cell organism.  It needs moisture, a warm temperature and any of a variety of sugars to grow and multiply.  In its growing it metabolizes the sugar and releases carbon dioxide and water as do other living creatures.  For the bread to rise, the dough must be able to trap this carbon dioxide.  This is done with a protein component of the flour called gluten, which can be bought in a grocery or health food store as vital wheat gluten.  The main difference between pastry and bread flours is the amount of gluten in the flour.  Pastry has very little gluten so it makes a flaky crust good for pies and such.  Bread flour has a healthy amount of it allowing for fluffy bread.  There are some individuals who are allergic or sensitive to gluten.  People with Celiac disease also known as non-tropical spue, because it causes a severe diarrhea that leads to mal-absorption of vital nutrients and severe illness, must avoid gluten.  So my recipe doesn’t apply to them.

            With this knowledge, we can make a nice fluffy loaf of bread as long as we provide the yeast with the right amount of a sugar, a grain base and liquid.  The sugar must have some nutritional value, i.e. not some artificial sweetener.  I like molasses and honey but I’ve used sweeteners including agave (a nectar derived from a cactus), malt syrup, and a variety of jams or preserves.  The liquid can be anything from tomato sauce to milk.  The key ingredient is adding one-third cup of vital wheat gluten to the mix to catch the carbon dioxide bubbles.

            Two other ingredients that finish off the bread are a teaspoon of salt (which seems to be necessary for anything tasty) and two tablespoons of oil, which keeps the bread tasting moist.  The amount of added salt should be reduced if one of the liquid components has it already in it.  The oil can be any of a variety of healthy choices such as flax seed, canola or olive oils.

            So here is the formula added in the sequence that works best for use in a bread maker:

            2 tablespoons oil- use to coat the bottom and sides of the bread pan.

            8 ounces of liquid-the actual measure may be more since you estimate the actual water content of the liquid by subtracting out the solids in the liquid such as tomato sauce or milk.  You may need a slightly larger amount of liquid in the dry winter months.  The dough should ball up and be sticky.

            1-teaspoon salt- adjusted down if salt is in the liquid already.

            2-tablespoons of sweetener – use the oiled spoon to measure the thick liquids such as malt and molasses as it will slide off more easily.

            Add 2 and 2/3 cup of flours to the liquid mix.  I like whole wheat or whole grain spelt to which I add in 1/3-cup amounts rolled oats, oat brain, rice flour, barley flour, or rye flour.  It works best when the non-flour elements such as oats are kept to less than one cup total.

            Next add 1/3-cup vital wheat gluten

            Finally add 2 heaping teaspoons of yeast.  By putting this in last you keep the yeast out of its growing environment until mixed, allowing for a delayed start to the bread maker.  Nothing beats waking up to fresh baked bread.  One final word of advice, most bread making machines have two general settings.  One for a quick bread that allows for two timed rises and regular setting that gives 3 rises.  Paradoxically, the 3-rise setting didn’t seem to work as well leaving the bread flatter.  I suspect this is due to the yeast running out of a sugar source.

            You can add any variety of other left over ingredients from pumpkin, rye or sesame seeds, and spices such as basil or cardamom.  Garlic powder, raisins, dried fruit even chocolate chips can be added in reasonable quantities and the bread should still rise.

            Experiment and enjoy this anything goes bread.

Excerpts for my work in progress: It could be worse

Since I was a teenager I have been reframing things.  My mother was an anxious woman who worried about many things.  In order to not upset her I realized that things had to be packaged positively.  I became adept at repackaging many things that could be interpreted negatively into thing that were positive.  I was able to observe the effect on my mother.  Was this a form of deception or self-preservation or therapy?  After becoming a psychiatrist I learned that a whole brand of psychotherapy was based upon this same notion of reframing.  It is called cognitive therapy.  It is one of the few types of psychotherapy that has been clinically proven to help people overcome a variety of mental symptoms including anxiety, depression and interpersonal problem.  What began as a game soon became a form of self-preservation and now a form of treatment.

            Several studies have been done that demonstrated that depressed individuals were more accurate in interpreting a video vignette that was showing a negative interaction between two people.  Most depressed patients would conclude that this was proof that their negative perceptions were correct.  This would reinforce their belief that they need to continue to hold fast to their negative views of the world.  In another study of 2800 cardiac patients, those who score highest on a pessimism scale were thirty percent more likely to die in the next 15 years.  So would you rather be more accurate or alive?

            I clearly favor the optimistic perspective.  What value comes from this more accurate interpretation?  It leads to or perpetuates a negative mood state.  It fosters paranoia and discontent.  My view is more aligned with a statement I observed on a tee shirt on a website for the TV show House.  It read, “Reality is highly over-rated.”  I am not proposing that we totally disregard the facts that may lead to our demise.  This is not a simple dichotomy as presented in the move, The Matrix, where we have a choice of pills.  Taking one pill shows us reality and the opportunity to change it.  Taking a different pill puts us into a state of total denial and enslavement.

            More recent studies have pointed to better health among individuals with positive attitudes.  In one large study carried out over 16 years, those who had a more optimistic scores as measured on a rating scale were 30% less likely to die.  Deaths were mostly from cardiac reasons.  One explanation was that the optimists took better care of themselves.  Alternatively, being pessimistic resulted in more stress or the perception of greater stress.  Perception may become reality.

            I am proposing that reality can be viewed in multiple ways.  It is as if two people are looking at a rectangular box.  The one looking head on at one end sees a two dimensional square.  The other looking at a slight angle sees a three dimensional box.  In the two dimensional object there is nowhere to go or turn.  It is flat without space.  In the three dimensional world there is room to grow and expand.  We are not as trapped and have more options.  In this case our negative views become forms of enslavement or denials of alternative perceptions of reality that opens new opportunities.

            I once learned an off color joke about a monkey, an elephant and three scientists on a deserted island.  The scientists trained the monkey to put in and remove a plus from the elephant’s rear end.  After the monkey was proficient in this task the plug was left in the elephant for four weeks.  Upon this time the scientists released the monkey to remove the plug from the elephant whilst the scientists observed from a comfortable distance.  Upon completion of the experiment the scientists compared their observations.  The first scientist reported, “I saw tons and tons of excrement coming from the elephant.”  The second scientist agreed, “It was amazing.  I’ve never seen so much animal dung in my life.”  The third scientist had a different take, “I saw a poor desperate monkey trying to put the plug back in.”  There are always at least two viewpoints to every situation.  Clearly one is affected by whether you are on the dumping or receiving end of a lot of excrement.

            My first book, Psychiatry in Techno Colors: a psychiatrist’s memoir of lessons learnedabout diagnosis and treatment of anxiety and depression focused more on psychopharmacologic interventions.  I realize that medications are not the only therapeutic intervention that I do.  I have often joked that medications work better when I give them.  This is more a reflection of some of the simple interventions that I do while prescribing medications.  I believe most of these interventions fall into the category of encouraging cognitive reframes or different ways of viewing situations.

            When discussing reframes or positive thinking, I think of the extremes as presented in Voltaire’s Candide or its modern satirical 1968 movie take off, Candy that had more sexual bent.  In both cases the main character could only see the good in everything while harm and exploitation was done to them.  Candide would remark after each atrocity that it was all for the best in the best of all possible worlds.  Candy likewise saw only the good in others' exploitation of her.  I don’t see these as models of appropriate reframing but of cautionary tales of taking positive thinking to absurd limits.  Outright denial of reality is doomed to fail as an intervention but it is possible to see alternative perspectives that give us more control over our environment.

            One model for depression is the learned helplessness model.  This is when the individual after multiple failures gives up trying.  There are two experimental models of this in animals.  One is the swimming rat in the beaker paradigm.  In this experiment a rat is placed in a large beaker of water.  The walls are too high it to climb out of and it swims furiously to keep afloat.  Just as it begins to sink from exhaustion the experimenter rescues the animal.  After being placed in the same beaker for several experiments the animal gives up trying sooner and sooner.  Some have suggested that the animal has just learned to not bother since it will be rescued anyway, but the next experiment implies otherwise.  The second learned helplessness model consists of a large cage divided into two sections with an electric metal floor throughout but a lever switch on one side.  A rat is placed in each compartment and the electric current is turned on.  After jumping around helplessly the one rat discovers the lever switch that turns off the current.  After several shocks it has learned to turn off the current fairly quickly.  Both rats have received that same shocks but they behave very differently.  The rat in the side with the switch behaves normally.  While the rat without the switch appears anxious, shaky, doesn’t sleep well and eats poorly.  This rat improves with antidepressant medication.

            So one can see from this learned helplessness model that having a sense of control over ones environment can mean the difference between an aversive stimulus being passed off a just a nuisance or making us profoundly depressed and needing antidepressant medication.

Sorry sale is over. Kindle version a best seller for several weeks

The book is available again on Amazon.com.  The full version on the Kindle is back to special price of $9.99.  Don't be confused with the sampler and Anxiety in Techno Colors for $0.99 each.  These are shortened versions with chapters focused on memoir in the sampler and anxiety in Anxiety in Techno colors. Thanks for making the kindle version #1 for over a week.

Special sale on kindle edition

For a limited time while my cover is being re-edited, the price of the full kindle edition is dropped to $2.99 and the 2 sample versions are $0.99.  This will only be for about one week.  This is the must read book for anyone struggling to understand why psychiatrists do what they do.

White Rabbit recomments Psychiatry in Techno colors

Why do psychiatrists recommend so many medications?  Why don't they do psychotherapy as much? Why can't they tell me what my diagnosis is?  Why does my diagnosis always change?  Why am I on an antipsychotic medication when I'm not crazy?  Why am I on lithium when I'm not bipolar?  Why does my doctor want to give me a medication for bipolar when I'm not?  Why to people attempt suicide?  Am I the worst patient? Am I making my shrink crazy or was he that before?  What is a panic attack and panic disorder? What would Freud do?  Can analysis be worthwhile?  Is the theater really dead? 
All of these questions and more (except the last one-the theater lives) are answered in Psychiatry in Techno Colors .
When the logic and proportion have fallen sloppy dead...remember what Dr. L said, Don't dread, feed your head.

A message of hope to all veterans and their families

I worked at the VAMC for several years and got an appreciation for the sacrifice our veterans and their families have made.  My thoughts and prayer go to all of you on this special day.

Next book talk/ signing in Farmington

I will be at the Millrace Book Store on Mill St in Farmington on Saturday June 11, 2011 from 2-4pm for a book talk and signing.  Books will be available to purchase at the store.  This is a beautiful location in an old mill overlooking the Farmington river above the Grist Mill Restaurant.
Here is link for directions: millracebookshop.com/directions/

Should my book have a different title?

I just returned from a writers and publishers conference and was advised that my book title may not truly reflect its content or audience.  I conceived the book as for a general audience of individuals who either suffer from depression and anxiety, their families or treatment providers.  I hoped to shed light on the problems in diagnosing and treating these problems in the hope that a more informed consumer would have a better outcome.  I also want to provide justification for a more rational approach to taking medications rather than the usual dogmatic extreme views.  Not accepting medications deprives the individual of hope, while an over reliance on medication deprives the individual of the satisfaction of helping oneself in therapy.  Unfortunately, extremist viewpoints taint healthy medium in many areas our world

book signing NAMI Lecture

Come join us

May is Mental Health Awareness Month

Advocacy Unlimited, Inc.

proudly sponsors:

Neil Liebowitz, M.D.

author of:

Psychiatry in Techno Colors

A Psychiatrist's Memoir of Lessons Learned About Diagnosis and Treatment of Anxiety and Depression

 

Tuesday, May 3, 2011

 at

UCONN Health Center,  ARB Seminar Room

7:00-9:00 p.m.

ADMISSION IS FREE

BOOKS WILL NOT BE SOLD AT EVENT

PLEASE CONTACT US TO PURCHASE A BOOK PRIOR TO THE EVENT

RSVP by April 12th , via email to info@mindlink.org

or call toll free in CT only (800) 573-6929 or  local (860) 667-0460

Refreshments will be served

Why I wrote Psychiatry in Techno Colors

My early psychiatric development took place in the epoch between AF (after Freud) and BP (before Prozac).  This was an interesting time.  Freud demystified psychiatric illness taking it from the realm of the spiritual and brought it to the phantasmagorical.  He created hope that mental illness could be understood through careful introspective exploration.  However, his followers really developed a new secular religion.  Psychoanalytic theory was based upon fantasized assumptions that when repeated enough were taken as gospel.  Any challenge to the theories was viewed with distain and analysts repeatedly resisted efforts to do controlled research into the efficacy of the treatment.

            As a secular religion it relied heavily upon the faith of the followers to make investment in often four to five time per week therapy sessions.  Patients were instructed to pour out their inner thoughts and much like believers going to confessional hoped for absolutions of their traumas from the fatherly analyst.  Patients went with the hope that their symptoms would be resolved but the analysts’ goal was insight and not symptom reduction.  When new medications came out that reduced symptoms, they scoffed at this “superficial” treatment.  They argued, rightfully, that patients’ symptoms returned after discontinuation of medications.  Yet they failed to demonstrate that their analytic treatment even reduced symptoms at all and were not some spontaneous symptom reduction that would occur with years of treatment.

            The analyst’s theories and beliefs were very compelling and powerful.  With intensive treatment they could enter a patient’s mind and cure its defects as no medication could do.  Faith it its efficacy lead to even the Catholic church sending its impaired priests to analytically oriented programs at the Institute of Living.  It wasn’t until I had been in practice long enough to see that patients who had years of analysis were not cured.  I got to see a fair number who had treatment by some of the best analysts and their symptoms were coming back.  When I treated them successfully with some modern medications, they confessed that their symptoms never really remitted with therapy but that they had learned to live with them.

            This wouldn’t be so bad an outcome, learning to live with one’s symptoms.  However, these were some of the least ill patients.  Analysts correctly chose to work with the least ill, realizing that analytic therapy often made patients with severe mental illness worse.  The shame was the abandonment of the chronically mentally ill and relegation to state hospitals.  But as these state hospitals continued to close at an accelerated rate, these chronically mentally ill patients were faced with a community system that didn’t know how to handle or treat them.

            My first rotation in psychiatry was in 1980 when the DSMIII first came out.  This was the most significant break that psychiatry made with its analytic past.  In categorizing disorders it removed all the analytical fantasy based assumptions and replaced it with symptom categories.  This allowed for testing of various treatments to see their efficacy against specific symptoms.  This was true not only for medications but also various therapies.  The analysts refused to participate in these efficacy trials despite being offered Federal grant money.

            When Prozac came out there was great excitement for finding better and safer medications.  The next epoch of AP (after Prozac) was characterized by a focus on rapid discovery of newer and better medications.  Unfortunately, these new medications had new side effects, like metabolic problems.  One set of side effects was replaced by another set.  Still the effect was improved acceptance of the medication.  Still there was not a cure.  Gradual improvement, but complete remissions were not frequent enough.

            We are now at a new juncture in psychiatry.  This is a richer and more broad minded epoch.  We are recognizing that therapy is still vital to treatment but we have new evidence-based therapies, cognitive behavioral, dialect behavioral, exposure therapy, cognitive remediation, among others.  These are more practical problem solving types of therapies.  They work in conjunction with medications.  We are learning the importance of lifestyle changes.  Prevention strategies of drug and alcohol avoidance, healthy diet and exercise regimes all may prevent initial presentations or relapse.  These strategies invite the patient to become a participant in his or her own recovery.  Active participation in one’s treatment also involves self-advocacy.

            What does self-advocacy mean?  I see it having many facets.  This ranges from being more effective in communicating with one’s provider about symptoms, medication side effects and functional difficulties to advocating for breaking down stigma barriers.  Connecticut has been at the forefront in the efforts to reduce stigma.  We were one of the first states to have true parity in mental health insurance coverage.  People like Karen Kangas put themselves in the public arena showing that individuals with mental illness could be effectively treated and be exceedingly productive members of society.  They are role models showing that mental illness should be treated like any other illness.

            I wrote Psychiatry in Techno Colors partly to destigmatize and demystify what a psychiatrist does in diagnosing and choosing treatments.  I describe some of the traumas and conflicts that I had in my psychiatric training and how I came to reconcile the differences between what I was taught with what my patients were telling me.  I try to explain symptoms in a language that may facilitate a patient or family members communication with a prescriber.  We now have a broad array of treatments both medications and therapies.  We are beginning to learn some of the genetics and triggers to illness.  We recognize the benefits of healthy diet and lifestyle to emotional as well as physical well being.  The goals of treatment now are remission of symptoms not just symptom reduction and prevention of relapses that impede recovery of function.  The future looks bright.  We still need families and patients to continue to advocate for stigma reduction and prevent the taking away of hard fought parity laws and ADA protections.

Stop discriminating against people who take psychiatric medications

            Many people criticize psychiatric disorders for being vague and arbitrarily defined.  I hear people say depression is just a matter of degree.  They claim to have periods of sadness so why medicate people?  They say that psychiatric illness is not like medical illness because they can’t get a simple blood test to prove its existence.

            My response is to point out that the most common medical syndromes for which people take medications are just as arbitrarily defined.  This includes, diabetes, hypertension and heart disease.  Autopsies on soldiers reveal evidence for atherosclerotic disease in 20 year olds.  What degree of vascular occlusion merits medical treatment?  Should a stent be put in an artery that is 50%, 60%, 70%, 80% or 90% occluded?  Does the patient have to be symptomatic to have a procedure done?

            What is the glucose cut off for a diagnosis of diabetes?  For treatment with medications?  It used to be over 200.  Now it is 120.  As more evidence for future complications became evident, the optimal blood sugar levels began to get lower and lower and include patients who had no overt symptoms.  The same is true of cholesterol levels.  Millions of people take statin medications and have no symptoms other than a blood test out of a statistically defined range.  Many of these people suffer severe side effects from the statins including muscle aches and depression.

            But somehow more criticism is given to doctors prescribing antidepressants to people who are suffering severely from depression and anxiety.  These symptoms greatly impair the patient including risk to loosing their jobs and relationships.  Every psychiatric disorder list in the DSM (Diagnostic and Statistical Manual) includes a set of criteria that requires the symptoms to be severe enough to cause impairment in function and not be due to another condition including medical illness.  This is not true of all medical illnesses for which medications are given.  Patients are given a blood pressure medication for having a blood pressure reading above an arbitrary cut off.  This cut off has been lowered over the years appropriately reflecting knowledge of risk factors.  Still the criterion is just a number without any other symptom needing to be present.

            Why are patients suffering from depression and anxiety chastised for accepting medications to treat it while others are not for taking blood pressure lowering, glucose lowering or cholesterol lowering agents?  Aren’t these patients as much to blame for their conditions due to lack of dietary discretion and exercise?  Vulnerabilities towards mental illness are at least as biologically and genetically based as other common medical conditions.  So it is about time this false argument against use of psychiatric medications is understood for what it is, it’s discrimination pure and simple.

I was on WNPR Colin McEnroe's show at 1pm on Tuesday March 15

I'm looking forward to being a guest on Colin's show tomorrow.  For those who are outside the listening area you can hear the show on WNPR.org.

Here is a link to the show
http://www.yourpublicmedia.org/node/11349

Comment on NYTimes article on death of psychotherapy for psychiatrists-is it so bad?

I say good riddance to the one parent model of Psychiatry (Talk doesn’t pay, so Psychiatry turns instead to drug therapy, March 6, 2011).  For too long psychoanalytic treatment models have been allowed to dominate the profession.  Major Psychiatric illnesses have a clear biologic basis and the treatment is extremely complex.  While psychopharmacology has progressed so has psychotherapy techniques.  I seriously doubt that anyone can be an adequate master of both.  The role of the modern psychiatrist is to be the director of a team, assessing, diagnosing, and providing appropriate psychopharmacologic intervention compatible with a multitude of physical concerns while collaborating with well-trained psychotherapists.  In the one parent psychoanalytic model, the psychiatrist is often derailed from finding psychotherapy coping techniques while switching hats to see if a medication change is in order.  The data needed to determine what medication is best overlaps little with the data needed to develop a comprehensive cognitive behavioral coping strategy.  Having a separate therapist who cannot prescribe medications forces the patient and therapist to devise strategies for coping while medications are given needed time to work.  This avoids harmful premature medication changes in desperate efforts to reduce symptoms.  This is not just a cost issue.  I have been using this model of collaborative treatment successfully for over 20 years and is the model of choice for hospitalized patients.  Do you expect your orthopedist to provide your physical therapy?  Both require highly technical skill sets.  Psychiatrists have complained about such “divided” treatment.  I see it more as the two-parent model collaborating while providing complementary interventions for the benefit of patient.
      In addition, psychiatrists complaining about not being paid for doing psychotherapy often belittle the skill of none physician therapists.  I personally received therapy from three different individuals, an MD, PhD and MSW.  I can say the most helpful was the MSW.  The patient's treatment experience and outcome is greatly enhanced by a collaborative effort as each can add insights to help the mutual effort.  This is true of every complex endeavor from flying a plane to surgery.

An alternative to gay marriage, no marriage

The New Jersey legislature in response to recent court rulings should consider getting out of marrying people.  Marriage begun as a religious institution and should remain so.  Civil governments should only issue licenses for civil unions that would between two, unrelated, consenting adults.  Marriage can occur between individuals in their chosen place of worship after having signed civil union agreements.  Existing marriages can be grandfathered by the state to be declared civil unions under a new law, and any existing laws pertaining to marriage can be declared to apply to any new civil union or “grandfathered marriage”.  The new civil unions would have all the rights, benefits and obligations of current marriage laws, except for any religious obligations or restrictions as to religion, gender, race, creed or color.  All divorces would involve application of any existing divorce laws to the new civil union where the word marriage is replaced by civil union.

            People of faith should not fear “the institution of marriage” being corrupted by the prospect of gay marriage.  Each house of worship can chose how it wants to deal with this issue.  Since the state would only recognize civil unions, state recognized gay marriage would become a non-issue.  Gays and straights would be accorded the same legal rights and protections under civil unions; religious and non-religious individuals would be free to practice their own beliefs without interference from the government as our constitution demands. 

With this modest proposal, hopefully all parties could end this divisive debate and live happily ever after.

Bipolar one, bipolar two, bipolar two and half, bipolar spectrum, and now for something entirely different

The case for a new diagnosis of cyclical mood disorder NOS.

 To the editor:  We have read the February 2006 edition focusing on the “Problems in the treatment of Bipolar disorder” with great interest.  One of the major issues in both study and clinical treatment is making a meaningful diagnosis.  This was touched upon in the editorial by Swann and in the research article of Perlis, et. al which compared features of unipolar to bipolar disorders.  However, we believe that there is a strong need for a new diagnosis, cyclical mood disorder, which captures a substantial number of patients who present with highly recurrent unipolar symptoms but respond poorly to antidepressants and preferentially to mood stabilizers.

There are three major reasons for the need for a new diagnosis.  The first is the poor response to treatment.  These patients based upon DSM IV criteria should only be diagnosed with major depressive disorder.  Non-psychiatric providers, following evidenced based protocols would be forced to go through innumerable futile or worse trials of antidepressants.  The second reason is stigma.  Even if a reliable diagnostic genetic marker were identified for bipolar disorder, this would stigmatize patients who have never manifested symptoms of mania.  This discrimination is currently evident in the Connecticut Bar Association’s, application that specifically asks applicants if they have ever been diagnosed with Bipolar disorder.  Internal medicine avoids stigma in several conditions by recognizing early syndromes as distinct from their more severe illnesses. For example patients with impaired glucose metabolism might be treated to prevent diabetes but are not given that diagnosis.

Finally, the validity of research studies necessitates accurate diagnosis.  The entrance of cyclical mood disorder patients into unipolar depression trials, unfairly introduces a bias against active treatment.  It may be the reason for failure of most medication trials in adolescent depression.  Early intervention with a mood stabilizer to a depressed young person may avert the appearance of bipolar symptoms and hopefully the associated morbidity and stigma.

We propose the neutral term “cyclical mood disorder, NOS” since it neither implies unipolar or bipolar diathesis.  Symptoms would include all the current criteria for major depression but have the additional criteria of a certain number of prior episodes.  These episodes might include subsyndromal episodes and have the frequency indexed according to age.  For example an adolescent may only require 2-3 episodes in two-year period, while a 30 year old require 5-10 episodes.  Research analysis can be done to choose an appropriate cut off frequency.  Ancillary criteria would include family history of bipolar, poor response to antidepressants without a mood stabilizer or “poop-out” of antidepressants after several months of good response with adequate dosage, prominence of atypical symptoms and energy dsysregulation.

We hope that introduction of this new diagnosis should inspire new research and advance clinical treatment.  Since it represents a reclassification of already diagnosed patients, it should avoid criticisms of creating diagnoses in to expand a population needing treatment.

Thoughts on the slaying of a psychiatrist in 2008

Cure The System, Treat The Patient

February 17, 2008

A recent incident in which one mental-health provider in private practice was slain and another seriously wounded in New York City [News, Feb. 14, "Doctor Hacked To Death In Office"] should stimulate outrage at the systematic dismantling of our mental-health system caused by cuts in funding for programs serving the seriously mentally ill.

Over the past few decades, thousands of individuals lost access to long-term treatment when states eliminated hospital beds to shift costs onto an overburdened Medicare and Medicaid system, pushing increasingly ill patients onto an ill-equipped private sector.

Private insurers have reduced hospital lengths of stays to dangerously short periods. Even if patients could afford to pay for longer stays, these hospitals had to modify their programs so that little if any therapy occurs.

Advances in psychiatric treatment have been dramatic and inspiring. Severe mental illness, however, is associated with actual loss of brain tissue. New treatments help to re-grow brain cells, but this can't occur if patients return to the same environments that triggered their episodes.

Our haphazard medical system pays for procedures costing hundreds of thousands of dollars to prolong someone's life for several months. But it denies payments for respite and psychiatric rehabilitation services at a fraction of the cost that may restore patients to normal levels of function.

The failures of this inequity are seen in tragedies reported in New York and in cities around the country. The irony is that society pays the costs in increases in crime, swollen prison populations and lost job productivity.

A useful review of Techno Colors

This book is a collection of essays, but they are not written in the academic style that one might expect. They are unified by simple language, a practical clinical approach, and by the author's sharing of many clinical pearls. Some of the essays are very personal and describe the challenges faced by the author in his education and professional development, going from residency to academia to private practice.
Primary care doctors will find the book helpful, especially the chapters dealing with panic disorders. In fact, his mother suffered from panic disorder and his descriptions of growing up and watching his mother's difficulties are touching. His humanistic approach to mental illness is manifest throughout the book.
He explains how his interest in painting and mixing colors helped him to develop his approach to sometimes treating psychiatric illness by using a combination of drugs. He refers to red and blue as his defining colors. Blue is associated with calming an anxious patient, red in adding fire and motivation to depressed patients. Purple was the blended color used to find a harmonious middle ground. On page 64 he actually shows the "color chart" of various psychotropics that he devised and which may be helpful to clinicians who understand his approach.
He mentions various drugs used in treatment of Attention Deficit Hyperactive Disorder (ADHD) and his personal experiences using them. He also describes neurotransmitter pathways; and how low serotonin levels can bring on compulsive activity, panic attacks, depression, and lowered sense of well being. The benefits of selective serotonin uptake inhibitors (SSRI) in helping to alleviate these symptoms are also mentioned.
Throughout the book his personalized approach is highlighted; for example he says that for a person with irritable bowel syndrome, with depression, using a drug that has constipation as a side effect may cure both their depression and their IBS.
The chapter on panic and anxiety has much practical information. Also discussed are evidence-based medicine and how they can be misleading. He finished with a detailed summary outlining how to treat depression that primary care doctors will find helpful.
Edward J. Volpintesta MD

Feeding my posting to Amazon's author's page

I think I've connected this blog to my Amazon's author's page.  If you are seeing this on Amazon and want to see old posts check out psychiatryintechnocolors.blogspot.com

Lawsuit against Merck for Propecia and panic disorder

I just read a new article anouncing that some people had filed a lawsuit against Merck Pharmaceuticals claiming that their medication propecia caused them to have panic attacks.  Since panic disorder is so common in the general population especially in a young population also most concerned about hair loss I can't see how a causal relationship could be made.  I have had young men start to panic about their hair loss as they worry about their attractiveness to women (even though many woman seem to think balding men are sexy).  Propecia is a low dose (1mg) of the prostate shrinking medication Proscar (5mg) and has significantly lower side effects.  Although, I know nothing about the specifics of this case and can't comment on the individuals I think there is a lesson to learn about seeking legal help as a diversion to getting real psychiatric care.

Patients who have panic attacks link these attacks to whatever happens at the time.  I've had patients associate a particular exit on the highway with their panic attacks and avoid it.  This is classical conditioning.  (See my chapter on Panic in my book http://www.amazon.com/s/ref=nb_sb_ss_i_0_14?url=search-alias%3Daps&field-keywords=neil+liebowitz&sprefix=neil+liebowitz)
It is unfortunate that there is such a stigma to treatment for psychiatric conditions that patients would rather blame anything else for causing their symptoms than realize that they need psychiatric treatment.  Panic disorder is very treatable, especially if dealt with early. The longer it goes the harder it is to treat.  Filing lawsuits  and blaming others only delays real effective intervention.

thoughts on Israel and the middle east

The purpose of my next book is to use reason to reinterpret our negative thinking and hopefully see things in a more positive light.  I had a patient ask what I thought of the recent turmoil in the Middle East and its effect on Israel.  Historical records reveal the Jewish presence in the area that is Israel going back thousands of years. The Jews were expelled and killed resulting in a diaspora.  Hitler's Holocaust led to recognition that Jews had no safe place to go and were not wanted in the rest of the world. Also that over the centuries they were displaced from their original homeland in the middle east.
 Growing up, learning of the Holocaust and reading Robert Frost's poem, Death of the Hired Man, I was struck by the line, "home is the place where, when you have to go there they have to take you in."  The Jews clearly didn't have this place until Israel.

The dictators in the Arab world have used the presence of Jews in Israel as a distraction from their subjugation of their people.  But you can fool only some of the people some of the time.  The closest to a rational argument against Israel has to do with the displacement of the local Arab population during the division of Palestine between Jordan and Israel.  Interestingly Jordan which was to be the Arab partition isolated the displaced refugees and only since the Israeli occupation of additional territory has the emergence of semi-autonomous Palestinian region emerged.  Interestingly, fellow Palestinian Arabs didn't feel they had a home either as monarchs and dictators chose to use them as pawns, kept in refuge camps rather than treat them like family.  Critics fault Israel for wanting to keep a Jewish state (I say homeland) likening it to apartheid.

I think that the closest analogy is to the creation of sovereign native nations within the United States after our Native American holocaust.  These were lands given to the former inhabitants of the area often displacing local residents.  No one suggests that Indian nations allow non tribal members to vote or call it apartheid.
One hopes that the citizens of the newly liberated Arab nations recognize the distraction that the Israeli conflict has been and reduce their interference of honest negotiating for a two state solution. In this case a new Palestinian state may emerge similar to the demilitarized sovereign Indian Nations in the US, creating a home for both families-Jews and Palestinians, who are clearly scions of the same stock.

So what does this do with psychiatry?  The anger associated with this conflict causes people to get depressed and leads to prejudice that hurts others.  When one sees things from a different perspective we can have more empathy for others reducing tension and grief.

Abridged versions of my book

By the way, I've created two abridged versions of Psychiatry in Techno Colors for the kindle.  Anxiety in Techno Colors has five chapters that deal with anxiety and panic.  I thought this would give helpful insights into understanding this terrifying condition.  It is about 40 pages of text and sells for $2.99 on Amazon.   Remember that a free Kindle app is available for hand held devices and a free Kindle previewer for computers. 
free kindle apps  The second abridgement is a little shorter and includes more of my memoir pieces more of a sampler sampler selling for only $0.99 the lowest price that Amazon would let me do.  Enjoy.

After the first post

Now that I've published my first book Psychiatry in Techno Colors, I've gotten excited about the next.  This book was mostly about my strategy for understanding problems and deciding on treatments.  My next book will focus on the supportive and interpretive statements that I've given patients to help them see things differently.  The tentative title is It could be worse.  This different is mostly in a positive way.  In psychiatry this may be called cognitive reframes.  I don't always reframe in a positive way.  Some individuals do self destructive things such as drug abuse or self harm and think that they are not really hurting themselves or others.  Here I might point out how non productive these behaviors might be.  At any rate I might use this blog to help others to "reframe" their problems.  I don't intent to provide free psychiatric help without examining you, as that would be irresponsible and against my malpractice coverage.  But I believe that as person who has cared for a lot of patients, I can provide hope and some direction. Please be advised that comments posted might end up in my next book!

book press release

Psychiatrist’s collection of essays aims to challenge misconceptions in field

 Neil Liebowitz’s “Psychiatry in Techno Colors” uses clinical vignettes to improve our understanding of major mental illness

FARMINGTON, Conn. – While psychiatry has come under attack for its alleged checkered past concerning over-reliance on medication, Neil Liebowitz, MD argues this claim is false in “Psychiatry in Techno Colors” (ISBN 1456316435). His book outlines why commonly held beliefs are distortions of reality. It further argues that a skilled psychiatrist can help a patient heal and return to a productive and happy life. This collection of essays ranges from understanding panic disorders to selecting depression medication, and each chapter concludes with a solution or strategy to resolve the dilemma. This book is written on a level intended to suit the general public, yet it also aims to provide enlightening insights and strategies for any clinician.

“My primary message is one of hope,” explained Liebowitz. “Hope that anxiety and depression can be understood and treated if patients and providers are better informed by an experienced clinician.”

The book’s messages include overcoming the psychiatry stigma, differentiating drugs of abuse from those that heal, failings of diagnoses and clinical trials, understanding how ADHD differs from bipolar disorder and understanding memory problems associated with medications.

Liebowitz founded the Connecticut Anxiety and Depression Treatment Center. He shares personal stories that illustrate some patient dilemmas and possible solutions for key psychiatric problems. From growing up on Long Island to residency training at Yale, to an academic career at the University of Connecticut, this doctor learned how best to understand psychiatric problems and properly treat them.

The author’s 28 years of practice have helped him develop strategies for conceptualizing patient problems.

“I feel that   mainstream psychiatry may miss the mark for many patients,” he said. “Psychiatry has been held back by wrong theories and an establishment that is slow to reconsider old notions.”

“Psychiatry in Techno Colors” is available for sale online at Amazon.com and other channels.