I use an ongoing spreadsheet to keep track of and to report my demographics and stats for each telepsychiatry consult shift I do. We have now gone over thirty thousand consults as a group.
It never ceases to amaze me, as I fire up my computer, log on to my systems and bring up the spreadsheet for the shift ahead, that one column is remarkably uniform and consistent, sometimes for days at a time: SI.
SI stands for suicidal ideation. And that is one of the most common chief psychiatric complaints we see in the emergency department. Continue reading
Anxiety and joint hypermobility: An unexpected association – Current Psychiatry. 2018 April
Joint hypermobility syndrome (JHS)—also known as Ehlers-Danlos type 3–hypermobile type (hEDS)—is a poorly recognized connective tissue disorder characterized by increased joint laxity that may affect 10% to 25% of the general population.
Researchers are increasingly recognizing an association between JHS/hEDS and psychiatric symptoms and disorders, specifically anxiety.
In this review, we describe the clinical presentation of JHS/hEDS, propose a new “Neuroconnective phenotype” based on the link between anxiety and JHS/hEDS, and discuss factors to consider when treating anxiety in a patient who has JHS/hEDS. Continue reading
Brain structure and joint hypermobility: relevance to the expression of psychiatric symptoms – Br J Psychiatry. 2012 Jun – free full text /PMC3365276/
This is not a new article, but a thorough scientific survey of the brain differences seen in people with hypermobility (which is usually undiagnosed EDS). This was the beginning of my understanding that EDS is not just a physical issue, but also affects our minds.
To me, it makes sense that the same instability (lack of balance, tendency to extremes) found in our bodies would also be represented in our brains/minds.
Joint hypermobility is overrepresented among people with anxiety and can be associated with abnormal autonomic reactivity. Continue reading
Below are three PubMed studies from 2015 about the detrimental effects of EDS on the mind/brain:
OBJECTIVE: The heritable disorders of connective tissue (HDCTs) are a group of genetic disorders affecting connective tissue matrix proteins. Continue reading
Below are 4 articles from PubMed that show EDS is associated with anxiety, depression, and other disorders of the central nervous system, like fibromyalgia and irritable bowel syndrome.
Connective tissue is *everywhere* in our bodies (yes, including our bones), so the defects in our body tissues extend to the brain as well.
I’ve been plagued by periods of desperate anxiety for the last decade and periods of suicidal depression for all my adult life, so I’m not surprised that the instability and slackness of our bodies are also manifested in our psychology. My moods never feel stable and can easily be derailed.
The number of possible EDS symptoms seems infinite… Continue reading
I’ve read too many articles that insinuate chronic pain arises from pre-existing mental issues and claim the focus should be on the mental disorder more than the pain. (This is part of the popular idea of “catastrophizing“)
But this article makes it clear that pain leads to “psychological” disorders, not the other way around as many would like us to believe. It is known that the unremitting assault by pain is a form of chronic stress that damages brain structure and connectivity. Continue reading
This Month’s Expert: Andrew Goddard , M.D., on The Role of GABA in Anxiety | Psych Central Professional – An interview with Andrew Goddard , M.D.
TCR: Dr. Goddard, you’ve done a lot of neurobiological research in anxiety disorders. It’s a very complex area, but basically what goes on in patients’ brains when they have a panic attack?
Dr. Goddard: It is complex, and initially researchers focused on the actions of monoamines in both depression and anxiety. The “monoamine theory” of depression holds that depression is caused by a depletion of norepinephrine and serotonin.
TCR: Is anxiety thought to result from the same thing? Continue reading
Whether we feel happy, engaged and full of energy is derived from the belief that we are in harmony with the world around us.
We maintain this sense of harmony by viewing ourselves, others and the events around us in a relatively benign light: things are fine, we’re safe.
When we perceive the slings and arrows of life as non-events – when we can say: ‘It is what it is’ – we can face difficult circumstances and effectively disarm potential emotional landmines. Continue reading
Online Therapy Shows Promise But Raises Plenty Of Ethical Questions – May 2017 – by Jessica Goodheart
For pain patients who have trouble transporting themselves to the weekly appointments required for therapy, this could be a solution. However, I have doubts about how effective it could be for the supposed “catastrophizing” for which we are urged to seek therapy.
These were some of the “success stories” posted this month on the website of Sunnyvale-based BetterHelp, one of a handful of online therapy companies that substitutes the often hard-to-access office visit to a therapist’s office with a suite of online offerings.
Many who need mental health care can’t afford it, while many regions suffer a severe shortage of mental health professionals, and even in counties rich with therapists, many lack the time to make the visit. Continue reading
Heralded as a revolution in mental health care – a cost-effective way to deliver evidence-based psychological help to large numbers – low-intensity Cognitive Behavioural Therapy (CBT) is recommended by NICE, the independent health advisory body in England and Wales, for mild to moderate depression and anxiety.
Prior studies into its effectiveness have been promising. However, little research has looked at whether the benefits last.