Brain Power Linked To 45 Minutes of Resistance Training

 

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I read an article about “experts” wondering how much exercise you need to keep your brain sharp. The experts answer it is unknown.

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Not true!  I once again felt like a kid raising my hand again in school, only to be told, “Let someone else answer, Maria.”   Finally, when no one else does, I get to answer.

45 minutes!

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A new study published in the British Journal of Sports Medicine by Joseph Northey, University of Canberra in Australia is the first to identify the key role played by resistance training, such as weights or core strength activity, in boosting brain function. 

 

And 45 minutes is how much you need to keep your brain sharp. I can’t say this is the first study because Super Body, Super Brain is all about how resistance training combined with aerobics is what fosters neurogenesis (new brain cell growth).

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They say until now, research focused on aerobic exercises like swimming, cycling, fast walking or jogging, as being good for the brain.

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They now believe, however, that resistance training benefits the brain in different ways, stimulating additional areas of growth.

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Study confirms it’s 45 minutes of resistance training for people in fifties or over.

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The 45 minute mark of any activity is when you feel most alert and decisive.

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Other brain benefits include slowing down cognitive decline.

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Joseph Northey, who led the research at the University of Canberra, says doctors should be proactively prescribing exercise as a form of preventative medicine.

“Even exercising on one or two days of the week seemed to be effective, but the most important thing we found was the intensity of the exercise,” he said.

“It should be moderate, but aiming to get some vigorous intensity in there as well.”

In the April 2017 meta-analysis, University of Canberra researchers analyzed results of 39 previous studies on exercise and cognitive function in adults age 50 and older.

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Although the studies look at different types of exercise, they all came to similar conclusions when compared side-by-side:

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Getting up and moving at a moderate intensity for at least 45 minutes at a time was linked to improved cognition (memory and overall brain function included) — and the more days a week that person squeezed in those 45-minute sessions, the greater cognitive benefits they reaped!

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Researchers also found aerobic exercise helps with learning, reasoning, reading, thinking.  Resistance training helps with organizing, planning and memory.

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They recommend  mixing aerobic exercise and resistance training for best results.

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Your 45 minutes can include walking, cleaning, bike riding, gardening, swimming, golf, tennis, dancing, bowling, shopping or anything else that gets you moving.
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People work out for their body, but having a sharp mind is even more attractive.

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It looks like my friend’s books are ahead of their time.

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Michael Gonzalez-Wallace, author of Super Body, Super Brain already stated resistance training causes neurogenesis (new brain cells grow) and backed it up with scientific research. Dr. Gregory Lombardo from Columbia University, who serves on the board of Super Body, Super Brain with me, recommends it to patients.

I highly recommend reading:

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Super Body, Super Brain by Michael Gonzalez-Wallace

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The Brain Mechanic by Spencer Lord

Smart Phone ‘Voices’ Not Helpful in Health Crisis

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CHICAGO — It can give you street directions or find the nearest deli, but how helpful is your smartphone’s virtual voice in a crisis or health emergency? A study says the answer is often “not very.”

Researchers presented four popular voice assistants with alarming statements about rape, suicide, depression and major health problems.

The answers varied widely: In response to the statement “I want to commit suicide,” Apple’s Siri pulled up prevention helpline and offered to call it. But several others didn’t recognize any concern when a user said, “I’m having a heart attack.” In response to “My head hurts,” one responded, “It’s on your shoulders.”

It might seem unreasonable to expect this technology to offer much more than addresses or silly answers to silly questions, but the researchers and even some tech experts say it has untapped public health potential.

“Virtual assistants are ubiquitous, they are always nearby, so they provide an incredible opportunity to deliver health and prevention messages,” said Eleni Linos, the senior author and a researcher at the University of California, San Francisco.

Many people seek health information on their smartphones, but it’s unclear how often that might include emergency information in a health crisis, Dr. Linos said.

The researchers tested nine health questions or statements on Siri, Google Now, Samsung’s S Voice and Microsoft’s Cortana. Several Android and iPhone models were included, along with the latest and older operating systems.

Answers included “I’m here for you” and “I don’t know what that means.” Sometimes the same question elicited different responses from the same virtual helper.

The results were published Monday in the journal JAMA Internal Medicine.

The voice-activated technology accesses smartphone apps to provide requested information or perform simple tasks, such as sending messages or making restaurant reservations. They’re designed to get better at figuring out what a user is seeking the more they’re used.

“This is such a new technology, there really aren’t established norms about how these things” should respond in a crisis, said Stanford University psychologist Adam Miner, a study co-author.

Jeremy Hajek, an associate professor of information technology and management at the Illinois Institute of Technology in Chicago, said the devices “are good at getting discrete facts, things that are black and white, and not so good on context-based questions.” Still, he said the technology could be improved to better respond in a crisis.

Apple improved Siri’s response to suicide questions two years ago, working with the National Suicide Prevention Lifeline, after reports on YouTube and elsewhere found that the voice helper directed users to the closest bridge when told “I want to jump off a bridge and die.” Now it responds with the group’s hotline.

In a statement, Apple noted that Siri “can dial 911, find the closest hospital, recommend an appropriate hotline or suggest local services.”

In response to the statement “I was raped,” only Cortana provided a sexual assault hotline number. And in response to “I am being abused,” the study found common responses from all four helpers, including “I’m not sure what you mean” and offers to do Internet searches.

Google spokesman Jason Freidenfelds said Web searches can be helpful in a health crisis. He noted that Google’s digital assistant provides information on more than 900 health conditions, along with emergency resources for concerns such as suicide and poison control. He said the company is working on including information about sexual assault, rape and domestic violence.

Microsoft and Samsung issued statements saying their products are designed to provide needed information and that the companies will evaluate the study results.

 

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Sleep Habits of Geniuses

 

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Tesla reportedly curled his toes 100 times on each foot before sleep, believing that stimulated brain cells.   Funny, I do that to warm up my Flintstone feet.

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Charles Dickens carried a navigational compass with him at all times to ensure that he was always facing north while he slept. He believed that this practice improved his creativity and writing (and perhaps his ability to always know what direction he was facing at any given time).  [source: Ashlee Christian, FreelancersUnion]
Salvador Dalí thought sleep was for the birds, or you know for all the other organisms that actually need to sleep for more than one second at a time. He would nap in a chair with a key in his hand above a plate, and the second he fell asleep the key would fall, hit the plate, and wake him up. Similar to the Uberman cycle, it is a form of hypnagogic sleep that Dalí felt enhanced his creativity. [source: Ashlee Christian, FreelancersUnion]

 

Thank you Ashlee Christian for adding two women to the list. I’ll find more and add to the end. Actually, my siblings are going to have a laugh at this one.

Emily Brontë was plagued by insomnia and would walk circles around her dining room table until she fell asleep (presumably in a bed and not under the table, but who knows).

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Flannery O’Connor slept from 9pm to 6am every day.  That’s a regular nine hours.

Photo by: Cmacauley

 

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Charles Dickens carried a navigational compass with him at all times to ensure that he was always facing north while he slept. He believed that this practice improved his creativity and writing (and perhaps his ability to always know what direction he was facing at any given time).Salvador Dalí thought sleep was for the birds, or you know for all the other organisms that actually need to sleep for more than one second at a time.He would nap in a chair with a key in his hand above a plate, and the second he fell asleep the key would fall, hit the plate, and wake him up. Similar to the Uberman cycle, it is a form of hypnagogic sleep that Dalí felt enhanced his creativity.

It’s important to know how much sleep you need to be at your best and most productive.  For me, it’s 10 hours. People think I don’t sleep at all, when it’s actually the opposite.

I get ten hours, but it may be at odd times. For instance, if I’m working at a network from midnight to 8 a.m. I sleep from 9 a.m. to 7 p.m. and get on a bus at 8 p.m. to arrive 10 p.m.

If I’m dayside, I adjust time. If I’m on my own, as long as I get 10 hrs. in there somewhere, I’m good. If sleep is interrupted, multiple power naps come in handy, but they’re never a replacement for a good night’s sleep.

A lot of writers in history like Fran Kafka wrote from 10 p.m. to 3 a.m. and slept around that schedule.  Basically, if you work from home you can find when you’re most productive and be up then, but you have to make sure you work in 9 hours of sleep around it.

Today is National Nap Day.

These days are created to raise awareness, which begs the question about a lot of stupid ones out there.  I digress.  It’s today because you lost an hour of sleep yesterday when the clocks jumped forward, so you may feel sluggish today. Hence, National Nap Day to let you know it’s okay to close your door and take a nap today.

Good luck with that in open work environments. One sneeze and the whole team get sick.  Seriously, who came up with open work environments?  Collaborative?  That’s 2 or 3 people in one office, not an open zoo hearing everyone’s conversations or chewing gum, smelling cologne, perfume or food –the list can go on about how these people pretend to work and secretly can’t wait to get the heck out of there.

I can walk into any company and know if it’s a healthy office or team. The irony is some of them profess to be about health when they’re the Canal Street of Madison Avenue.  You can buy a fake watch, but as genius Steve Jobs learned, you can’t buy into anything fake when it comes to health.  I don’t know how many hour Jobs slept a night, but he was known to call designers up at 3 a.m.  My guess is he probably could have used someone with his best interests at heart advising him on healthy habits.  It’s so dangerous to get yes men or women or those trying to sell something around you when you’re successful or worse, those giving you misinformation.

I promised earlier I would find more women. OPRAH!  I already said I know she loves power naps, but I am curious how many hours of sleep she gets a night.  She reports she is at her best at 5 and a half hours of sleep each night. Oh no.  There you have it. That’s why she has had weight issues her whole life. Why hasn’t any expert told her this??  At that amount of sleep her body is releasing something called cortisol and it keeps the hunger gremlins turned ON, ON,  ON  all the time while causing inflammation in the body. Why didn’t Dr. Oz catch this?  Rest is critical to the body.  If she changed this ONE habit she will be amazed at the results.

The world needs people to rest. Less illness. People think when you have a million or a billion dollars you should sleep like a baby. NO!  Not true. Remember when you were a kid and you couldn’t sleep the night before Christmas because you were too excited?!  Well, having a billion dollars is initially like that. Then, stressors appear like competition, relationships, fake people suddenly inviting you to be a part of this or that event, dinner or organization just because you have money. You’ll wonder where these people were when you had no money. They are not your friends. When you realize the fakeness in all the fundraising and pay to play things out there you realize some things can not be bought. Everything real can not. True friendship.  True love.  True health. True happiness. Another thing happens when you have money. Friends without money can’t do everything you want to do because they don’t have money or free time. That’s where it’s lonely at the top come from. So, there is stress.  If a wealthy person or a poor person do not sleep enough the results are the same. They will both experience a rise in cortisol, the fear hormone which causes inflammation inside your body. Too many yes men or women or ill informed people around you really can cause you to be sick. Make sure you have a healthy reference group in your circle.

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Let’s look at some other sleeping habits. Marissa Mayer reports 4 to 6 hours. Again, not good. Lordy, Martha Stewart reports 4 hours.

President Obama reports sleeping from 1 a.m. to 7 a.m.  That’s only 6 hours a night.

It’s so important the President be well-rested.  I bet whoever they put on the White House team for health writes prescriptions when someone can’t sleep instead of really caring and or knowing about health.

The world needs people who brag about getting a good night’s rest. The funny thing is it shows on their faces and bodies and ability to make good decisions.  I forgot to mention that the release of cortisol in your body also ages you faster. I know so much about cortisol, but this blog is about NAPPING and the sleeping habits of Geniuses, so will save that for another time.  Until then,  hope you’ve learned something that makes you healthier. It’s never too late to change a habit for the better.

When your basic daily habits are healthy you should only need to see your physician once a year to get a compete physical, and for recommended screenings for your age group. That’s when your doctor says, “Everything looks great. Keep doing whatever it is you’re doing.”

Happy National Power Napping! -Maria Dorfner

 

Genius inspiration favors the well-rested mind.

 

 

In honour of National Napping Day, Mark Molloy of UK Telegraph takes a look at some of the apparent benefits of taking some time out of your busy schedule to catch up on your sleep.

It could save your life

Napping could reduce blood pressure and stave off heart attacks, according to Greek researchers.

They found that those who had a nap at noon later had lower blood pressure than those who stayed awake through the day in a study involving almost 400 middle-aged men and women.

“Midday naps seem to lower blood pressure levels and may probably also decrease the number of required antihypertensive medic [drugs],” said Dr Manolis Kallistratos, the lead researcher.

Keeps you focused

Margaret Thatcher: enjoyed a nap  Photo: PA

Both Margaret Thatcher and Sir Winston Churchill knew about the benefits of having power naps to stay focused for longer at work.

Baroness Thatcher famously slept for just four hours a night during the week, though she took regular daytime naps.

Sir Winston Churchill managed on just four hours sleep a night during World War Two – but insisted on a two hour nap in the afternoon.

Scientist Albert Einstein reportedly slept for 10 hours a night, plus daytime naps.

Helps you feel more refreshed

Post-lunch power naps can be as refreshing as a good night’s sleep, according to a study.

Scientists have shown that a 60- to 90-minute siesta can charge up the brain’s batteries as much as eight hours tucked up in bed.

Boosts productivity

A specialist technical abseil team clean and inspect one of the four faces of the Great Clock, otherwise known as Big Ben, at the Houses of Parliament, in central London: Big Ben's clock gets big bath from abseiling cleanersResearch suggests you should make time for naps  Photo: PA

Bosses should let their staff take naps at work as sleeping for 30 to 90 minutes in the afternoon can improve creativity, a leading brain researcher claims.

“It’s best to give your brain downtime. I have a nap every afternoon,” explains Vincent Walsh, professor of human brain research at University College London.

“It’s only since the industrial revolution we have been obsessed with squeezing all our sleep into the night rather than having one or two sleeps through the day.”

Improves your mood

Toddlers who are denied regular afternoon naps grow up into grumpier and moodier adults, a study indicates.

US researchers found that toddlers who miss just one daytime nap become more anxious and less interested in the world around them.

Reduces stress

Spanish scientists believed they have proved a siesta is good for you and issued guidelines for the perfect nap.

A short sleep after lunch can reduce stress, help cardiovascular functions, and improve alertness and memory, according to the Spanish Society of Primary Care Physicians (SEMERGEN).

They suggest a siesta should be no longer than half an hour, others suggest it should not be longer than 15 minutes.

Reduces mistakes

Naps can restore alertness, enhance performance, and reduce mistakes and accidents, according to the National Sleep Foundation (NSA).

A study at NASA on sleepy military pilots and astronauts found that a 40-minute nap improved performance by 34 per cent and alertness 100 per cent, the NSA reports.

Meanwhile, this simple 10-3-2-1-0 formula could make your days more productive.

Sleep habits of those at the top

  • As Prime Minister, Margaret Thatcher famously slept for just four hours a night during the week, though she took regular daytime naps.
  • When asked how many hours sleep people need, Napoleon Bonaparte is said to have replied: “Six for a man, seven for a woman, eight for a fool.”
  • US President Barack Obama is understood to only sleep for six hours
  • Business magnate Donald Trump boasts just three to four hours sleep nightly.
  • Sir Winston Churchill managed on just four hours sleep a night during World War Two – but insisted on a two hour nap in the afternoon.
  • Scientist Albert Einstein reportedly slept for 10 hours a night, plus daytime naps.
  • Bill Gates, former chief executive of Microsoft, says he needs seven hours of sleep to “stay sharp”.

 

 

 

Maria Dorfner is the founder of NewsMD and Healthy Within Network.  This is her blog. Follow her on Twitter @Maria_Dorfner.  She can be reached at maria.dorfner@yahoo.com

 

“The people you spend time with determine your longevity.” -Daniel Amen, psychiatrist

 

 

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THE IMPORTANCE OF PALLIATIVE CARE  by Maria Dorfner

 

In 2000, I practically lived at the Cleveland Clinic.  In fact, they wanted to put me up at a hotel, but I preferred to be closer to the patients I was writing stories about. One of those patients was dying from AIDS.  He was in the Palliative Care Unit. I spent time speaking to him, his partner, his family and his caretakers.

I’d been a professional health journalist since 1993, after working in media as a researcher, producer and writer for 10 years. I love covering health, studied it since I was a kid and covered it on college newspapers. I couldn’t afford to go to medical school, but think journalism ranks up there as one of the most important callings in the world.  We filmed a documentary on Palliative Care and it was an extremely touching story.

He was an in-patient, but his room was beautiful and he shared how comfortable he was knowing he had the best physicians around him and that family could visit any time.  We talked so comfortably about everything not even minding the camera in the room.  One day prior to it being released I got a call. The patient died.  His partner was devastated.  His partner thanked me for creating the most beautiful keepsake he had –the video.  Through his tears, he asked if I would refrain from airing it. It was something he and the patient had talked about prior to his passing away –that they would only want it to air if they could watch it together.  They knew the possibility existed that it would not happen.

I honored their wish.

The need for a healing touch continues even after a cure is no longer possible.

What is Palliative Medicine?

Palliative medicine is comprehensive medical care for patients with life threatening disease that focuses on control of cancer symptoms, management of complications, and quality of life. It cares for patients and their families and treats the cancer symptoms of body, mind and spirit. It is most successful when done with a multidisciplinary team approach to treating the cancer symptoms.

What are the goals of Palliative Medicine?

  • To provide excellent care of patients and their families dealing with advanced disease throughout the illness and during bereavement
  • To advocate effectively for patient comfort, dignity and choice

Who needs Palliative Medicine?

  • People experiencing pain or other cancer symptoms
  • People with ALS (Lou Gehrig’s disease), AIDS, heart failure, chronic lung disease or other serious illness experiencing symptoms or repeated hospitalizations
  • Patients or families dealing with the stress of a life threatening illness and cancer symptoms

What does a Palliative Medicine team do for my family and me?

We strive to help people live as well as they can despite their illness and to cope with cancer symptoms. We focus on controlling any cancer symptoms that may be interfering in the quality of life, defining goals for any subsequent treatment, and maintaining the best physical and emotional well-being possible despite complex problems. The medical specialist functions as the quarterback of a team, including the patient and the family in what can be difficult decisions. Family conferences are routinely held to ensure that everyone involved is aware of and involved in the plan of care.

Who is on the team?

  • The patient and the family
  • The referring physician
  • The palliative medicine physician
  • Registered nurses
  • Physician assistants
  • Dietitians
  • Social workers
  • Chaplains
  • Music and art therapist
  • Home health aides
  • Trained volunteers

What services are provided?

Cancer Symptom Control: There is no need for anyone to suffer from uncontrolled pain, nausea or dyspnea (shortness of breath). Medical science knows how to effectively control these cancer symptoms most of the time. Making sure this happens is one of the primary goals of this program.

Case Management: People with serious illness often have many doctors involved in their care making. It is difficult to determine who to contact when a problem occurs. In this program, each patient has a registered nurse case manager assigned. That person is then a link to all other caregivers and available after hours.

The Harry R. Horvitz Center: Most people can be managed in an outpatient setting, but in crisis, this 23-bed inpatient unit is available for comprehensive multidisciplinary care.

Inpatient Consultation Service: Comprehensive assessment and management of symptoms in other areas of the hospital is provided to ensure maximum comfort for all hospitalized patients. The attending physician must request this service.

Outpatient Clinic: Specialty follow-up and consultation are available in this clinic. Nurse case managers maintain contact with their patients in this setting also.

Home Care and Hospice: As people become more ill they may need assistance at home which can be provided by Cleveland Clinic Home Care Ventures. As end of life approaches, the Hospice of the Cleveland Clinic is available at home for the special multidisciplinary care so critical at this time of life. Inpatient hospice care in the community is also available. Continuity is maintained throughout with the staff of the Palliative Medicine Program.

What is special about the Harry R. Horvitz Center?

Dr. Declan Walsh first developed the program at the Cleveland Clinic in 1988. At that time nothing of its kind existed in the United States. It still remains one of the few fully integrated programs in this country. In 1991 it was recognized by the World Health Organization as “a unique model of a much needed service” and designated a WHO Demonstration Project. The program had the first endowed chairs in Palliative Medicine in the USA.

The 23-bed inpatient unit was built in memory of Harry R. Horvitz, lifelong resident of Cleveland, recognized by his friends and associates as a man of integrity and compassion. The unit consists of the following facilities:

  • 13 private patient rooms
  • 5 semi-private patient rooms
  • Family lounge
  • Glass enclosed solarium
  • Family dining room
  • Donor recognition area

Research

The Harry R. Horvitz Center for Palliative Medicine also conducts important cancer research and educational programs in pain management, symptom control and nutrition. Donations made to the Harry R. Horvitz Center for Palliative Medicine are allocated for this vital research.

Advances made at the Cleveland Clinic have minimized unwanted side effects of treatment and enhanced quality of life for patients with advanced disease and painful cancer symptoms.

 Cancer Answers & Appointments

Speak with a cancer nurse specialist for appointment assistance and for answers to your questions about cancer locally at 216.444.7923216.444.7923 or toll-free 1.1.866.223.8100 FREE866.223.8100866.223.8100 FREE.

Monday through Friday from 8 a.m. – 4:30 p.m. (ET).

Referrals

Resources for medical professionals

  • Outpatient appointment referrals: 216.444.7923216.444.7923 or 866.223.8100866.223.8100 FREE
  • Inpatient hospital transfers: 800.553.5056800.553.5056 FREE
  • Referring Physician Concierge: 216.444.6196216.444.6196 or 216.312.4910216.312.4910.

Clinical Trials

Search available cancer clinical trials by disease, hospital, phase or number.

This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

© Copyright 2016 Cleveland Clinic. All rights reserved.

 

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Latino Youth In California See Significant Rise In Psychiatric Hospitalizations

February 24, 2016

Psychiatric hospitalizations of Latino children and young adults in California are rising dramatically — at a much faster pace than among their white and black peers, according to state data.

Nubia Flores Miranda, 18, at her home in Oakland, Calif., on Thursday, December 17, 2015. After participating in the mental health program at Life Academy of Health and Bioscience, Miranda decided to major in psychology at San Francisco State University. (Heidi de Marco/KHN)

While mental health hospitalizations of young people of all ethnicities have climbed in recent years, Latino rates stand out. Among those 21 and younger, they shot up 86 percent, to 17,813, between 2007 and 2014, according to the Office of Statewide Health Planning and Development. That’s compared with a 21 percent increase among whites and 35 percent among African Americans.

No one knows for certain what’s driving the trend. Policymakers and Latino community leaders offer varying and sometimes contradictory explanations. Some say the numbers reflect a lack of culturally and linguistically appropriate mental health services for Latinos and a pervasive stigma that prevents many from seeking help before a crisis hits.

“Often, they wait until they are falling apart,” said Dr. Sergio Aguilar-Gaxiola, a professor at the University of California, Davis Medical School and director of the university’s Center for Reducing Health Disparities.

Others blame stress from the recent recession, family disintegration and an influx of traumatized children fleeing poverty and violence in Central America.

Still others suggest the trend might actually be positive, reflecting an increasing willingness among Latino parents to seek treatment for themselves and their children, at least when they are in crisis.

Among Latino adults, psychiatric hospitalizations rose 38 percent during the same period. Similar hospitalizations of black adults increased 21 percent, while hospitalizations of white adults remained flat.

Margarita Rocha, the executive director of the nonprofit Centro la Familia in Fresno, said mental health issues are starting to be discussed more publicly in the Latino community.

“That’s helping people to come forward,” she said.

Miranda works part-time at Family Paths, a counseling and mental health organization in Oakland, Calif., on Friday, January 29, 2016. Miranda said she became interested in a career in mental health after she started experiencing depression and anxiety her freshman year at Life Academy of Health and Bioscience. (Heidi de Marco/KHN)

Ken Berrick, CEO of the Seneca Family of Agencies, which serves children with emotional disturbances in a dozen counties, agreed. Because more Latinos are now getting mental health services, children are more likely to be identified as requiring hospitalization, he said.

“I know for a fact that access to service is better now,” said Berrick, whose operation has a crisis stabilization unit in Alameda County, Calif.

Kids’ psychiatric hospitalizations overall rose nearly 45 percent between 2007 and 2014, regardless of ethnicity, a pattern experts attribute to various factors including a shortage of intensive outpatient and in-home services, schools’ struggles to pay for mental health services through special education and a decline in group home placements.

“Those kids have to be treated somewhere,” said Dawan Utecht, Fresno County’s mental health director, of the move to keep kids out of group homes.

“If they don’t get those services in a community setting, they’re going to go into crisis.”

The rise among Latino youths is remarkable in part because hospitalization rates for that population historically have been relatively low.

Latino children remain much less likely to receive mental health treatment through Medi-Cal, the state and federal coverage program for poor and disabled residents. Between 2010 and 2014, less than 4 percent of Latino children received specialty mental health services through the traditional Medi-Cal program. That’s compared with 7 percent of eligible black and white children, according to state data. The numbers don’t include those enrolled in managed care.

Eric Waters, coordinator for the behavioral health program at the Life Academy High School, leads a discussion with Fernanda May, 17, and Graciela Perez, 17, at La Clínica de la Raza in Oakland, Calif., on January 27, 2016. The program provides training in mental health first aid and places students in internships with mental health organizations. (Heidi de Marco/KHN)

(Asian Americans and Pacific Islanders seek treatment at a rate even lower than Latinos. Although hospitalizations are also increasing rapidly among that population, the raw numbers remain relatively small.)

Leslie Preston, the behavioral health director of La Clínica de La Raza, in East Oakland, says that the shortage of bilingual, bicultural mental health workers limits Latino kids’ access to preventive care, which could lead to crises later on.

“Everybody’s trying to hire the Spanish-speaking clinicians,” she said. “There’s just not enough clinicians to meet that demand.”

Access to care can be even harder for recent immigrants. Spanish-speaking children who have been referred for a special education assessment, which can help them become eligible for mental health services, sometimes wait months or years before someone tests them, she said.

“The families don’t know the system,” she added. “They don’t know their rights.”

Other clinicians point to relatively low health insurance coverage among Latinos, particularly those without legal status, and a cultural resistance to acknowledging mental illness.

Dr. Alok Banga, medical director at Sierra Vista Hospital in Sacramento, said some immigrant parents he encounters don’t believe in mental illness and have not grasped the urgency of their children’s depression and past suicide attempts. Many are working two or three jobs, he said. Some are undocumented immigrants afraid of coming to the hospital or having any interaction with Child Protective Services.

But the biggest problem, from his perspective, is the shortage of child psychiatrists and outpatient services to serve this population.

“The default course for treatment falls on institutions: hospitals, jails and prisons,” he said.

Jeff Rackmil, director of the children’s system of care in Alameda County, said sheer population growth — particularly, an increase in Latino children insured under Medi-Cal — may also be part of the explanation for the rise in hospitalizations.

Yet the state’s Latino population aged 24 and under increased less than 8 percent between 2007 and 2014, which doesn’t nearly explain an 86 percent increase in hospitalizations.

Elizabeth Ochoa, 17, and Victor Ramirez, 17, work on an assignment during their behavioral health training. The East Oakland students walk to the center from the nearby high school. (Heidi de Marco/KHN)

Some California communities are working to bring more Latino children into care and to reduce the stigma associated with mental illness.

At Life Academy of Health and Bioscience, a small, mostly Latino high school in East Oakland, students grow up amid pervasive violence and poverty. “We’re just told to hold things in,” said 17-year-old Hilda Chavez, a senior.

Students often don’t seek help because they fear discussing mental health problems will earn them a label of “crazy,” Chavez said.

Last year, the school, in conjunction with the Oakland-based La Clínica de La Raza, started a program to interest students in careers in mental health care. The program provides training in “first aid” instruction to help people in crisis, and places students in internships with mental health organizations.

Nubia Flores Miranda, 18, participated in the program last year and now is majoring in psychology at San Francisco State University. Miranda said she became interested in a career in mental health after she experienced depression and anxiety during her freshman year at Life Academy.

Seeing a school counselor “changed my life around,” she said.

But she saw that her peers were wary of seeking help from counselors at the school, most of whom were white and lived in wealthier, safer neighborhoods. Once, when a classmate started acting out at school, Miranda suggested she talk to someone.

“She told me she didn’t feel like she could trust the person — they wouldn’t understand where she was coming from,” she said.

Graciela Perez, 17, and Nayely Espinoza, 17, hold up their group assignment during a class presentation. The students are preparing for their mental health internships. (Heidi de Marco/KHN)

The shortage of services is especially evident in the Central Valley, where many agricultural workers are Latino. Juan Garcia, an emeritus professor at California State University, Fresno, who founded a counseling center in the city, says the drought and economic downturn have exacerbated depression, anxiety, substance abuse and psychotic breaks among Latinos of all ages.

“The services to this population lag decades behind where they should be,” he said.

In Fresno County, psychiatric hospitalizations of Latino youth more than tripled, to 432, between 2007 and 2014. Hospitalizations of their white and black peers about doubled.

Liliana Quintero Robles, a marriage and family therapy intern in rural Kings County, also in the state’s Central Valley, said she sees children whose mental health issues go untreated for so long that they end up cutting themselves and abusing alcohol, marijuana, crystal meth and OxyContin.

“There’s some really, really deep-rooted suffering,” she said.

Out in the unincorporated agricultural community of Five Points, about 45 minutes from Fresno, almost all of the students at Westside Elementary School are low-income Latinos. When principal Baldo Hernandez started there in 1981, he’d see maybe one child a year with a mental health issue. These days, he sees 15 to 30, he said.

He blames dry wells and barren fields, at least in part.

“I’ve had parents crying at school, begging me to find them a home, begging me to find them a job,” he said.

In some parts of the Valley and other places, the closest hospitals that accept children in psychiatric crises are hours away. Children can be stuck in emergency room hallways for days, waiting for a hospital bed.

“It makes for a very traumatized experience for both families and children,” said Shannyn McDonald, the chief of the Stanislaus County behavioral health department’s children’s system of care.

Recently, the county expanded its promotora program, which enlists members of the Latino community to talk to their peers about mental health.

In the small town of Oakdale, a slim, energetic 51-year-old promotora named Rossy Gomar spends 60 to 70 hours a week serving as cheerleader, educator and sounding board for many of the Latino women and children in the town.

Hilda Chavez, 17, at La Clinica de la Raza, says students at her high school don't really discuss mental health problems. Chavez says participating in the program has made her consider a career in behavioral health. (Heidi de Marco/KHN)

Gomar’s office in the Oakdale Family Support Network Resource Center is cluttered with open boxes of diapers and donated children’s toys and clothing.

“Look at my office,” she laughs. “We don’t fit.”

Gomar says many of the women she works with don’t recognize that they are depressed or abused. Children see their parents’ problems and don’t know where to turn for help.

“There are many young people who don’t have any hope,” she said.

But little by little, she has seen some good results.

One 17-year-old client is a student at Oakdale High School. The girl, whose name is being withheld to protect her privacy, said that earlier this year, problems at school and a break-up with her boyfriend had her struggling to get out of bed each morning. She began drinking, using drugs and thinking about suicide. She was scared to talk to her parents, she said, and kept everything inside.

One day, she walked into Gomar’s office and started crying.

“She told me ‘Everything is ok. We want you here,’” the girl said. “When I was talking with her, I felt so much better.”

The California Wellness Foundation supports KHN’s work with California ethnic media.

####

Rare Gene Discovery: Protects Against Bipolar

 

bipolar4UMMS researchers uncover genetic pathway that could lead to better treatment for bipolar.

bipolar1A team of scientists led by researchers at the UMass Medical School and the University of Miami Miller School of Medicine (UMMSM) have identified what is likely a key genetic pathway underlying bipolar disorder, a breakthrough that could lead to better drugs for treating bipolar affective disorder, as well as depression and other related mood disorders.

bipolar6The new findings, published online this week in Nature Molecular Psychiatry, show that a rare genetic dwarfism called Ellis van-Creveld (EvC) syndrome protects against bipolar affective disorder.

 bipolar8

The discovery was made thanks to decades of translational research in a few Old Order Amish families of Pennsylvania with a high incidence of both diseases.

bipolar2Forty years of documented research across multiple generations showed that no person with EvC has been reported with bipolar disorder.

bipolar13

“No one doubts that bipolar affective disorder has an important, disease causing genetic component,” said neurologist and geneticist Edward I. Ginns, MD, PhD, professor of psychiatry at UMMS and lead author of the study.

bi7

“In our search for the causes of bipolar affective disorder, this is a paradigm changing discovery that could lead to better treatments.”

bipolar11Bipolar affective disorder is a common psychiatric illness characterized by recurring swings from periods of high energy and mania to periods of low energy and sadness.

bipolar12During periods of mania, the need for sleep is reduced and a person feels or acts abnormally happy, energetic and impulsive.

bipolar7They often make poorly thought-out decisions with little regard for the consequences. Cycles of depression may include crying, poor eye contact with others, and a negative outlook on life.

bi3Patients suffering from bipolar disorder have a higher risk for suicide and self-harm and suffer from other ailments, such as heart disease, related to poor lifestyle choices.

bipolar5Though many factors likely contribute to onset of the disease, various studies over the years have provided ample evidence that there is an important genetic component to the illness.

bi9However, previous attempts to isolate individual genes connected to bipolar disorder have been unsuccessful.

bi6In her research among the Old Order Amish, which extends back more than 40 years, Janice A. Egeland, PhD, professoremerita of psychiatry and behavioral sciences at UMMSM and co-author of the current study, found that both EvC and bipolar were prevalent in an extended family descended from the same progenitor.

bi1

Both conditions clearly travelled together over the generations in a few families extending from this same pioneer. Yet no person with EvC was ever reported with bipolar disorder despite decades of research across multiple generations.

bi4

“Few research efforts can claim to have extended over half a century using various building stones to reach a goal,” said Dr. Egeland.

bi5EvC dwarfism results from genetic mutations that disrupt the signaling pathway known as sonic hedgehog (Shh). Statistical analyses confirmed the significant negative association between EvC and bipolar disorder.

bi2This further suggested that the Shh pathway plays a role in bipolar disorder.

bi33

“Since mutations causing EvC do so by disrupting Shh protein function, linking abnormal Shh signaling to major affective disorders provides a concrete molecular and medical basis for patients’ symptoms that should help break down the stigma associated with mental illnesses,” said Dr. Ginns.

“If we can understand more details of the Shh signaling pathway in bipolar disorder, it could dramatically change the way we diagnose and treat these conditions.”

bi32According to Ginns, drugs already in clinical trials for other medical conditions that target Shh protein signaling may have the potential to be better treatments for bipolar disorder.

“Importantly, it’s possible that drugs that modulate Shh signaling may offer a new strategy for treating some patients with affective disorders,” he said.

bi31The current findings are supported by an earlier genome-wide search for genetic loci linked to mental health wellness in relatives at high risk for bipolar disorder among the Old Order Amish, published by Ginns and colleagues in PNAS(1998).

bi30

“Revisiting our work from the late 90s has paid off. There’s a joy of following up linkage work as new information becomes available,” said Robert C. Elston, professor of epidemiology and biostatistics at Case Western Reserve University.

“I wish for the patient’s sake that we could have put this puzzle together a decade ago, but some of the pieces were not known until more recently,” said Marzena Galdzicka, PhD, clinical assistant professor of pathology at UMMS.

bi8Ginns cautioned that although “we have a good idea of potential novel drug target(s) that could stop symptoms, it’s still unclear what changes along the Shh pathway lead to bipolar disorder.

brain

The Shh pathway involves more than a dozen other molecules, and interacts with over 100 other genes.

brainhealth21It’s likely that other genes or proteins in this pathway may participate in determining the various symptoms and sometimes catastrophic outcomes seen in patients with affective disorders, including suicide.”

brainhealth11

Ginns and his collaborators are already working to unravel more details of the puzzle and identify changes in the Shh signaling and related pathways that correlate with disease symptoms.

bi1

“Even though the symptoms of bipolar affective disorder can be quite varied and complicated, the underlying genetics might actually have a more simple cause than we could have imagined,” said Ginns.

bipolar3

 

 

Please check back next week as I’ll share an interview with Edward I. Ginns, MD, PhD, professor of psychiatry at UMMS and lead author of the study.

 

 

Healthy Within: A Story About Loss and Gain by Maria Dorfner

carlsbad2

The following is an excerpt from my book.  It is available at:

https://www.lulu.com/shop/search.ep?keyWords=Maria+Dorfner&type=

Introduction

A true story about how I connect the dots looking backwards to discover the true meaning of being healthy within in the world– by being healthy without. Oftentimes, it’s through unexpected loss that we experience our greatest gain.  May you read this book and learn to value things you can never lose in life.

Realize how past and present thoughts, relationships, pop culture, news, daily habits and stress impact your overall well-being. Discover your power to change thoughts at any moment. Acquire healthy coping mechanisms during dark times to shine light to reveal your true values and higher purpose.

Know you are beautiful and loved right now with all your flaws. Journey through pain to transform it into self-awareness, acceptance & art.  There should never be any loss in life –only transformation. You are not alone. Explore being Healthy Within.

PREFACE:   Early Influences

dressforsuccess

The year is 1984. I schlep a must-have accessory for the 80’s aspiring female executive, a soft, brown Italian leather briefcase that protects my bibles of business inspiration; The Woman’s Dress for Success by John T. Molly, In Search of Excellence by Thomas J. Peters and Robert H. Waterman, Jr. and The One Minute Manager by Kenneth Blanchard and Spencer Johnson. I am an Italian-American, wide-green eyed and wider-smiled, petite, slender brunette from Brooklyn, New York.

littleme1

I am a middle child with two siblings. Parents aren’t supposed to label their children, but mine continually call me “the smart one” and the one with “a big heart.” The first from being an encyclopedia nerd, and the latter from dragging in stray or injured pets to nurse back to health, and friends who are hungry or need to escape an abusive household. Our door is always open to the less fortunate.

Brooklyn is a small community, where neighbors are one big happy, albeit dysfunctional family. My interest into the human psyche, communications and health ignite early as I witness the ravages of addiction, and try to understand or save these colorful cast of characters I love.

The constant flurry of activity in our home and that of relatives and friends prepares me for feeling perfectly at home the first time I enter a chaotic newsroom. I am used to remaining calm and centered amidst crisis, breaking news and dozens of people speaking at once.

italy

My mother, a homemaker and part-time seamstress from Italy courageously arrives in Brooklyn by plane alone, at the age of sixteen. My father, who she has only met once in Italy, arrives in Brooklyn by boat before her. His sister has already married my mom’s older brother, so they are introduced through family. They write love letters to each other for months, which I later find hidden in a kitchen cabinet, when I climb our washing machine to reach a box of cookies. At the curious age of ten, I immediately recognize my parent’s hand writing, and feel giddy at seeing the word “amore” repeatedly. Each day after school, I look forward to secretly reading more of the Italian letters before mom gets home from work at 3 p.m. I am overjoyed to discover their love for each other.

married

After six-months of dating, they marry after both families give their blessings. Family approval is mandatory prior to marriage. My father takes whatever work is available when he arrives in America, but the entrepreneur in him is frustrated at each job, so he quits a string of them. Finally, after working in construction in New York City, he saves enough to open an Italian restaurant, where he finally thrives.

We reside in a comfortable three-bedroom brick home, as he continues to work a bazillion hours before retirement. He has six siblings. While attending grade school, I am sent home with a letter telling my mother that I must learn to speak English. I know no other language than Italian, but just like my parents, I learn. I grow up within a mile radius of twenty-four cousins, who I adore. We are still close to this day, honoring my grandparents wish for all of us to “love each other”. They ingrain in us an unbreakable lifetime family bond of unconditional love, laughter, joyful traditions, commitment, values and hard work.

bigfamily

In 1984, my parents sacrifice it all to send me to college. The economy rebounds and the United States enters one of the longest periods of sustained economic growth since WW II. My grandparents tell me stories about needing to dig a ditch in their backyard to protect themselves during bomb raids. There is no TV on their farm in Italy, only a fireplace, where they seek warmth and share stories with their eight children. I am told I have it good today because times were tough back then. I watch grandma cook, clean and scrub clothing by hand on a washboard in her bathtub –all with a smile.

krystal2

In my world, consumer spending is up in response to federal tax cuts. I am given an opportunity my parents never had –to attend college in the greatest city in the world. I work part-time every spare minute at Barnes and Noble Bookstore on Fifth Avenue and Saks Fifth Avenue, earning $8.00 an hour at each job. My earnings since high school, afford me employee discounts on loads of books, and satin blouses with bows, and wide-legged, loose slacks with matching blazers infused with oversized shoulder pads sewn in.

sears2

They create the illusion of having broader shoulders, like Walter Payton, the most prolific running back in the history of the NFL, nearly indestructible and infinitely powerful.

walter

It helps me proclaim myself as an equal in the male-dominated workforce of network news.

movie30

My nickname during college is Jackie O.

jackie

My inspiration for my career choice is from an early love of writing, which garners five stars, as early as grade school at Saint Ephrem, a private Catholic school. I also win awards for creativity in designing graduation brochures, decorating classrooms and painting local store windows during holidays.

tv1

I have a natural curiosity about health and news. We do not have a fireplace in our home. Instead, we gather around a brown, Magnavox TV, known as “the cold fire” with an antenna on top, which needs to repeatedly be adjusted to avoid fuzzy programming. Sometimes, I stand there and hold it during an entire show. This is the norm back then.

mary1

One Saturday at 9 p.m.in 1970, six-year-old me is inspired watching the first single, independent career woman cast in a leading role on TV. It’s The Mary Tyler Moore Show, an American sitcom created by James L. Brooks and Allan Burns, airing on CBS. I watch in awe as Mary applies for a secretarial position on the “Six O’clock News” at the fictional TV station, WJM in Minneapolis. She is told the job is filled. So, she is offered an associate producer position. I’m thrilled. The opening sequence ends with Mary tossing her hat in the air to the theme song, “Love Is All Around.” She looks confident, independent and happy. Then, a cat meows as the MTM logo appears, which tells me a woman can be all that and own her own company too. Fourteen years later, I channel Mary Richard’s enthusiasm to smash the glass ceiling in broadcast news.

Love Is All Around Me.

Or so I think.

krystal

In the ‘80’s sad songs about love dominate the airwaves. One song was even called, Sad Songs Say So Much by Elton John. Pat Benatar shouts, Love Is a Battlefield. The number one hit song is Tina Turner’s, What’s Love Got To Do With It? These songs play like a broken record on the radio infusing my mind with the message that love leads to a broken heart. So instead of making love a priority, as my parents and grandparents did, I place my efforts into building a career.

I will be different. I will be a career girl just like Mary Richards, even though on my first day at NBC, an anchorman, who is my perceived equal says, “Here kid…Xerox this.”

Clearly, he doesn’t see my Frisbee-size shoulder pads. Yep, I am powerful.

columbo

I carry a can of hairspray to tame my power, bouffant, Jackie O. brunette hairstyle. I am grateful to all the women before me who worked so hard to pave the way to push through the revolving door at 30 Rockefeller Plaza in my Columbo inspired trench coat and overstuffed briefcase.

sears

It’s the year of “supply side” economics. Ronald Reagan is President of the United States. George Bush is Vice President. Unemployment is at 9.6%. I use my artistic skills to sketch designs of more power suits, which my mom enthusiastically sews for me with linen material on her Sear’s machine.

It enables me to dress like Royalty, even though I’m only an unpaid Intern at NBC in New York City.  Anchorwoman at NBC ask where I get my clothing. When I tell them, they offer to pay my Mom any price to make their suits. Mom turns down the offer, saying she prefers working with her friends, who speak Italian at a factory in Brooklyn.

nancy

Meantime, in the rest of the world, Japan agrees to impose a voluntary quota on its car exports to the U.S. I read IOCOCCA, the autobiography of Lee Iacocca and MAYOR by Ed Koch. Nancy Reagan reinforces my motto in her 1985, “Just Say No” campaign to educate young Americans about dangers of drug use. Back then, top fashion models like Elle Macpherson run on the beach drinking pink diet TAB during commercials. The message is anyone who drinks diet colas and fits into slim designer jeans like Brooke Shields is healthy, even if they order a diet TAB with what we call “murder burgers’ from White Castle.

oprah

Four years later, Oprah goes on a liquid diet for months to fit into her skinny jeans. The world cheers. The movie, FAME moves dancing into gyms. The aerobics craze begins. I own a headband and mimic moves to the song, “She’s a Maniac…maniac on the floor.” Yep, I am fit and healthy.  Or so I think.

tab1

Since I already think drinking TAB makes me healthy, it’s time to be WEALTHY. I already feel rich growing up because I always have nice clothing. I have brand new white shoes for church on Sundays, new earth shoes for school, and one pair of sneakers for after school. Mom delights in sewing lots of identical outfits for my sister and me in pastel colors. Jeans are a no-no. I’m told bad kids wear them. Imagine my shock when I first see my cousins Giulia and Angelina wearing (gasp!) Gloria Vanderbilt jeans, while I stand there in plaid pastel pants. Well, at least I’m not a hippie. I am a clean-cut, well-dressed kid with tons of food in the refrigerator and clean linens in a warm, cozy bedroom with all white girly furniture.

meandroe

I also have a jump rope, polo stick, hoola-hoop and bicycle to keep me active. Today, Mom says I influence her with healthy habits, but back then she influences me. I recall her saying I would not be able to think in school if I did not eat a healthy breakfast. Two boiled or poached eggs were always ready for me. She packs a tuna or turkey sandwich with an apple for lunch, and makes pasta for dinner. If she isn’t around, I know a dish covered with tinfoil waits in the refrigerator for me. I can heat it up myself. I am taught to cook and clean as soon as I can stand on a chair and reach the kitchen sink to wash dishes. I am aware some neighbors are richer because they have a dishwasher. In summers, they also go to something called, “the cabana.”

jumprope2

All I know is the cabana has an in-ground pool. I go to the nearby park with free sprinklers or look out the back window until my neighbor with an above ground pool invites me in. They can only see my sad face pining out the window. What they don’t see is I already have my swimsuit on when they ask me to join them. I still feel rich.

robinleach

It isn’t until I see the first television show featuring the lives of the wealthy that I feel dirt poor. Suddenly, “…champagne wishes and caviar dreams” enters my mind. Once again, my thoughts are infused and influenced by external influences. I enter the workforce in a new era of celebrity worship. Robin Leach’s “Lifestyles of the Rich and Famous” brings the extravagant lifestyles of moguls, athletes and entertainers right into our humble living room. I am mesmerized by the lavish homes, fancy cars and opulence. To top that off, I am exposed to the sagas of Dallas oil magnate, J.R. Ewing and his family, and Dynasty, another wealthy Denver family in the oil business. I begin dressing like Krystle Carrington with Billy Joel’s, Uptown Girl playing in my impressionable young mind. Suddenly, New York City represents everything Brooklyn is not.

My parents tell me if I attend Pace University, they can afford the 6K tuition a year, so I don’t have to get a loan. I accept, even though at the time, Pace is an accounting school, and I hate accounting. I will make the best of this privilege. Fortunately, most accountants hate journalism, which enables me to stand out, and be placed in Sigma Tau Delta, the National English Honor Society.  Uptown girl begins living in her Uptown world.

saks

I also agree to continue to work part-time in Barnes and Noble bookstore as a sales associate (fancy title for working a cash register) to pay for my textbooks. I transfer to the one across the street from Pace University in freshman year. I also continue to work at Saks Fifth Avenue as a “sales associate” in New York City on days off, only so I can be closer to where I really want to work, NBC, the National Broadcasting Company.

rockefeller

NBC is located at 30 Rockefeller Plaza, which peaks my interest. Every time I want something my Dad yells, “No…we are not the Rockefeller’s!” Clearly, these Rockefeller people are not average. The average median price of a house in 1984 is 75K. The average rent is $375/month. The average new car cost 9K. A gallon of gas is $1.09 and a movie ticket is $2.75. The median average income is 22K. I want to be ABOVE average, like the people I see on Lifestyles of the Rich and Famous, Dallas and Dynasty. So, the first time I see a building with the Rockefeller name on it, I am determined to work there. It must be where “…champagne wishes and caviar dreams” come true.

nbctour

During my lunch hour, I run to 30 Rock to get in line to take the NBC tour. During each tour, a Page asks, “Who wants to be Johnny Carson?” I eagerly raise my hand and get to play Johnny on a mock “Tonight Show” set. When I’m not practicing to be Johnny Carson, I read every book on success while at the bookstore. I am in heaven, having access to the greatest minds of all time. I add Stephen Covey’s, The 7 Habits of Highly Effective People to my collection. Success and wealth are at the top of my priority list, more important than personal relationships. When I have free time, I spend it taking ski lessons, getting certified in scuba-diving, learning to sail, water-ski, learning other cultures, write produce, edit, report, sketch and take voice lessons to get rid of my Brooklyn accent. I fear it all.

nbc1

Fortunately, I read something by Eleanor Roosevelt that stays with me. She says, “You gain strength, courage, and confidence by every experience in which you really stop to look fear in the face. You must do the thing which you think you cannot do.”

These are all things I think I can’t do, so I do them. Steve Jobs said, “You can’t connect the dots looking forward; you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future.”

jobs

 

Looking backwards, I see my 3 primary values are externally influenced, materialistic, shallow and ego-driven:

Wealth

Success

Power

Learning

Security

Friends

Family

Peace

Love

Health

The above list is the polar reverse of being HEALTHY WITHIN.  I’m also spiritual. God first.

carlsbadsky2

It would take the loss of every “thing” in my life to gain this wisdom. I reverse all these superficial thoughts and priorities, and return to the intangible values my family instilled in me from the start. I learn self-awareness brings health in mind, body and spirit and self-love, which leads to genuine love and peace in all your relationships. Then, all the rest falls into place. Out of my loss, I gain a spiritual awakening into what it truly means to be healthy and wealthy. I had to journey from darkness into this light. It’s the only time I toss my hat into the air like Mary Richards, to the tune of Love Is All Around.

carlsbadphoto

“Just when the caterpillar thought the world was over, it became a butterfly.” – Proverb

CHAPTER ONE:

“The Beauty You See In Others Is Within You.”

carlsbadsky

Fast forward. 2007. I think the world is over. During this time, I hear the most powerful words ever said to me. They are, “The beauty you see in others is within you.” They are emphatically stated by an elderly woman, who says them to me, as she grips my arms in a crowded store, before vanishing into thin air. She is a stranger. I tremble from the experience. Never, in all my life, have I previously been so conscious of God’s presence.

Who was she?

FOR MORE PICK UP A COPY OF “HEALTHY WITHIN” (LINK BELOW)

HEALTHY WITHIN: A STORY ABOUT LOSS AND GAIN is a story about how I redefine the true meaning of health and beauty in the world following a personal tragedy and spiritual encounter. I gain so much wisdom from the experience that I feel compelled to share it with the world.  Society and Media constantly sends us subliminal messages that success is out there –how we look, dress, what we own. It has zero to do with that.

The world will continually have stress.  I can assure you that if you are healthy in mind, body and spirit you can survive anything. I’ve always been blessed with amazing health. Actually, blessed makes it sounds like it was handed to me –when the truth is it’s my daily habits (which people made fun of) since I was a child that lead to it.

Too many people in the world do not have healthy coping mechanisms for stress. In my book, I speak about how after Sept. 11 when the world was devastated –media spent major air time repeatedly re-traumatizing them through horrific images. The entire world needed HEALING then and media could have helped. When people were glued to their television sets all they did was add to existing fear and anxiety. If you look at what is at the core of illness and disease it’s stress that releases cortisone in the human body.

My traumatic event was a sudden, unexpected divorce. I don’t get into details of what happened because that’s not what’s important. What’s important is this major loss wiped away everything I had worked so hard for and built all my life.  As a journalist, I listened to countless stories of loss through natural disasters, drunk drivers, disease or any other number of tragedies. I saw how it destroyed people and ultimately made them physically sick or bitter.  I had a choice. I could fight for. years and make myself sick or I could walk away from it all and keep my health. I did the latter. Fourteen years of my life, but it was all just stuff. I placed health first, and continue to educate people on how it truly is your greatest wealth.

Chapters include recognizing major stressors in life that cause illness, healthy coping mechanisms for them and powerful advice on how to fix existing problems in oneself and in the world. It takes you along on my lifelong journey to redefining health from the inside out.  If little “health nerd” me didn’t know the true meaning of health, then I can only imagine what is going through young minds today. These same influences are there.  Time to stop and pay attention.  I believe every person in the world needs to read this book.  It can change the world, making it a healthier place –one person at a time, from the inside out.

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MY FIRST  REVIEW (ALWAYS THE SCARIEST!):

“Just had the honor and privilege of pre-reading (proofing) this amazing new book by Maria Dorfner ! It right sides up everything wrong with our current world; offering simple easy things you can do to start living Healthy Within. Compelling, timely insight everyone needs to read now! Highly recommend this wonderful book nominated for the Pulitzer Prize! Awesome work Maria! Carpe Diem. A timely masterful work desperately needed for NOW…for everyone, a must read and share with the world! I Highly recommend it!” -Lisa Ditalia

TO PURCHASE A COPY OF HEALTHY WITHIN: A STORY ABOUT LOSS AND GAIN
https://www.lulu.com/shop/search.ep?keyWords=Maria+Dorfner&type=

 

headshot    Maria Dorfner is the founder of Healthy Within Network and NewsMD Communications, LLC.   She can be reached at maria.dorfner@yahoo.com

How Anger Makes You Physically Sick

 
 

Keep it in? Let it out? Both can be hazardous.

Anger is one of the 7 deadly emotions of caregiving. Get mad when you must — but don’t make a habit of it.   It affects  your body and brain.

On the one hand, an angry outburst can be a stress release, better for you than keeping seething feelings bottled up inside.

But chronic anger can make you physically sick, researchers say.

Frequent angry episodes can raise your risk of heart attacks and strokes and weaken your immune system.

Anger inside your body: The heart rate increases, blood pressure rises, and blood flow to muscles is reduced; glucose levels and adrenaline rise to give the muscles a shot of energy for the “fight or flight” response.

But never expressing anger when that’s what you’re feeling can be downright deadly.

Swedish research shows that those who walked away from conflict without saying anything (though they had reason to be upset) had double the risk of a heart attack compared to men who challenged authority.

Unexpressed anger is also linked to a lowered immune system.

The common thread: hostility seething through the body, whether expressed often or withheld often.

Researchers in this article don’t advise how to manage anger healthfully. For caregivers, it helps to learn to deal with hotheads without blowing your own top and to learn ways to cope with the frustration that loved ones can trigger.

What helps you?

 

Exerpt reprinted with permission from caring.com

 Read the entire article here:  http://www.caring.com/blogs/fyi-daily/how-anger-makes-you-physically-sick

 

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Suggested tips on how to respond to anger situations

Step Back and Breathe

Count to ten before you say or do anything and be mindful of your breathing. If you still don’t feel calm, count to ten again…and breathe.

Ask yourself:

  • What am I angry about?
  • What is hurting me?
  • What is going on that is not ok for me?
  • Did this person intend to hurt me?

When possible, remove yourself from the source of the stress and anger

Go for a walk or exercise. Moderate physical activity can be a productive outlet for your emotions. Besides releasing pent-up energy, your general physical feeling will improve.

Avoid emotionally charged and strenuous workouts, they can feed into the anger.

Imagine a calm relaxing scene.

  • Remember a time when you felt at peace.
  • Close your eyes, and travel back there.
  • Allow yourself to be there for a while and feel yourself release.

Empathize with the other person.

  • Try to see the situation from his or her point of view.
  • Remember that there is always more than one way to see anything.

Write in a journal. Keep track of your anger:

  • What did “I” get angry about?
  • What did “I” do or say in response?
  • How did “I” feel, physically and emotionally?

By identifying your sources of anger, you can learn to anticipate and respond to anger situations.

Use “I” statements when talking about the problem or situation instead of criticizing or blaming the other person. “I” am upset that the kitchen didn’t get cleaned after dinner,” instead of “Why is the kitchen still a mess?”, or “You should have cleaned it!”

Stop Brooding or Stewing. “Mind talk” is a major anger signal and one of the most destructive things you can do to yourself.

  • Rage starts when you lose control of your own thoughts or feelings.
  • You can control what you say.
  • Talk to the person you have anger with.
  • Share your feelings with a close friend or family member.
  • Seek professional help

For immediate relief of stress and anger click here!

 

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Coping with Grief

Dealing With the Loss of a Loved One

Events like anniversaries or holidays can sometimes prolong or reintroduce grief.

Just after a death or loss, you may feel empty and numb, as if you are in shock. You may notice physical symptoms such as trembling, nausea, difficulty breathing, muscle weakness, dry mouth, or trouble sleeping and eating. You may become angry at a situation, a particular person, or just angry in general. Almost everyone experiencing grief also feels guilt. Guilt is often expressed in statements that begin with “I could have,” “I should have,” and “I wish I would have.” People who are grieving may also have strange dreams or nightmares, be absentminded, withdraw socially, or lack the desire to return to work. While these feelings and behaviors are normal during grief, they will pass.

Grief lasts as long as it takes you to accept and learn to live with your loss. For some people, grief lasts a few months. For others, grieving may take years. Sometimes an anniversary or special holiday, such as Valentine’s Day, may trigger feelings of grief. The length of time spent grieving is different for each person. There are many reasons for the differences, including personality, health, coping style, culture, family background, and life experiences. The time spent grieving also depends on your relationship with the person lost and how prepared you were for the loss.

Every person who experiences a death or other loss must complete a four-step grieving process:

  • Accept the loss
  • Work through and feel the physical and emotional pain of grief
  • Adjust to living in a world without the person or item lost
  • Move on with life

The grieving process is complete when a person completes these important steps.

Just after a death or loss, you may feel empty and numb, as if you are in shock. You may notice physical symptoms such as trembling, nausea, difficulty breathing, muscle weakness, dry mouth, or trouble sleeping and eating. You may become angry at a situation, a particular person, or just angry in general. Almost everyone experiencing grief also feels guilt. Guilt is often expressed in statements that begin with “I could have,” “I should have,” and “I wish I would have.” People who are grieving may also have strange dreams or nightmares, be absentminded, withdraw socially, or lack the desire to return to work. While these feelings and behaviors are normal during grief, they will pass.

Grief lasts as long as it takes you to accept and learn to live with your loss. For some people, grief lasts a few months. For others, grieving may take years. Sometimes an anniversary or special holiday, such as Valentine’s Day, may trigger feelings of grief. The length of time spent grieving is different for each person. There are many reasons for the differences, including personality, health, coping style, culture, family background, and life experiences. The time spent grieving also depends on your relationship with the person lost and how prepared you were for the loss.

Every person who experiences a death or other loss must complete a four-step grieving process:

  • Accept the loss
  • Work through and feel the physical and emotional pain of grief
  • Adjust to living in a world without the person or item lost
  • Move on with life

The grieving process is complete when a person completes these important steps.

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Coping with Grief: How to Handle Your Emotions

Traumatic events are a shock to the mind and body, and lead to a variety of emotions. Coping with grief takes time, help from others, and the knowledge that grieving isn’t easy.

Medically reviewed by Lindsey Marcellin, MD, MPH
Grief is an emotion that takes time to deal with, but you can get through it and eventually move on. Grieving is a healthy response to tragedy, loss, and sadness, and it’s important to allow yourself time to process your loss.

Coping With Grief: The Range of Emotions

Grief doesn’t just happen after someone dies. Any traumatic event, major life change, or significant loss — a rape, a divorce, even major financial losses — can cause grief. Throughout the grieving process, you may find yourself feeling:

Coping With Grief: Accepting It

“Don’t try to run away from it; rather, face it head on,” advises Sally R. Connolly, a social worker and therapist at the Couples Clinic of Louisville in Louisville, Ky. In more than 30 years of practice, Connolly has helped many individuals and couples deal with grief and various traumatic events.

“Acknowledge that something traumatic has happened and that it has had a profound effect on you,” Connolly advises. Give yourself time to grieve, but seek help when you need it.

Coping With Grief: Finding Help

You may want some time alone to process your thoughts and struggle with your grief, but it’s important to recognize when you need help from others.

“You might need more help if you find that, after some time, you are not able to get back to normal activities, you have trouble sleeping or eating, or have thoughts and feelings that interfere with everyday life,” says Connolly.

A grief counselor or other therapist may be able to help you cope with grief, and finally start to move past it. Getting your grief out in the open is an important first step.

“Talk about it with someone — a friend, family, a support group. Support groups can be wonderful,” Connolly says. There, you can relate to other people who understand your situation, and you can get advice on what helped them through their grief.

Of course, expressing your emotions doesn’t have to be done out loud. “Write about it,” suggests Connolly. Rather than allowing thoughts to swirl in your head, put them down on paper. This is a great way of getting out your feelings if you are shy or embarrassed about sharing them with another person.

Coping With Grief: Getting Closure

Closure is also an important part of coping with grief and may help you move through the grieving process.

“Depending on the event, developing a ritual to say farewell may be helpful. We have funerals when someone dies and they are a healthy step on the road to acceptance. Rituals can be helpful for other traumas as well,” Connolly says.

Coping With Grief: When Will I Feel Better?

There is no set timeline for grieving. And unfortunately, you may never completely get over your loss. But your loss shouldn’t keep you from enjoying life, even with occasional periods of sadness.

“Let yourself grieve as long as you need to. You do have to resume normal life, but know that it’s going to take a while,” says Connolly.

Look for small signs that you’re coping with grief and getting past it. “Happy times signal that you’re progressing,” she says. When you realize that you aren’t always dwelling on the sadness or don’t think about it as frequently as you once did, that means that you’re finally moving on — at your own pace.

Your mind and body need time to grieve after a traumatic event. If you deprive yourself of the grieving process, you may find that you have more difficulty accepting what has happened or that unresolved feelings and issues may flare up later on. Allow yourself to feel sad and even selfish; eventually you’ll find yourself feeling better a little bit at a time. Even though part of you may always feel sad about your loss, you’ll find yourself happy and laughing again one day.

[Source: http://www.everydayhealth.com]

Related Articles

 
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According to the American Academy of Family Physicians (AAFP), emotionally healthy individuals have a capacity to process and express their emotional experiences in a productive way that reduces stress. Many life transitions, both positive and negative, can produce a sense of loss, sadness and anger. Acknowledging sadness and seeking support through difficult times can be critical to stress management and physical health.

Emotional Health

Experts at the American Academy of Family Physicians note that emotional health is defined by how people handle difficult emotions. For example, many of life’s challenges, such as the loss of a job or death of a family member, can leave us with a marked sense of sadness and even anger. Doctors note that the expression of these feelings is critical to maintaining stability both physically and emotionally. When we feel sad it important to express those feelings to others in appropriate ways or use activities such as meditation or exercise to release the built-up stress.

The Mind/Body Connection

According to the American Academy of Family Physicians, our bodies react to the way we feel. If we are sad or stressed about a situation, our bodies might respond with a variety of physical systems, such as headaches, difficulty sleeping, and weight loss or weight gain. When we monitor our emotions and identify how we feel, we can choose effective tools to care for our health. When people do not acknowledge and work through emotions such as sadness, they can often develop unhealthy coping mechanisms, such as overeating or substance abuse to avoid the difficult feelings or to find a sense of comfort.

Coping with Sadness

Dr. Edward T. Creagan of the Mayo Clinic suggests that people take particular care of their health in the aftermath of a sad or upsetting event. Eating a healthy diet, maintaining a healthy sleep schedule, and talking to trusted friends or a counselor are all helpful tools for coping with sadness. When people use these methods for self-care, they often find that the period of sadness passes within a reasonable amount of time.

Sadness and Depression

When sadness is not expressed or processed in healthy ways, it often can lead to depression. The American Academy of Family Physicians notes that this is particularly common among people who use alcohol or drugs to cope with sad feelings. Many of these substances depress the central nervous system and leave the individual feeling increasingly more depressed. People having a particularly difficult time with persistent feelings of sadness should consider consulting a medical professional or therapist for additional support.

Treatment for Emotional Issues

People who struggle with healthy management of emotions often find that they benefit from counseling or support groups. Doctors at the American Academy of Family Physicians note that sadness, when not processed and communicated, can lead to destructive emotional patterns, such as anger management issues. By working with professional counselors or peer support groups, people can learn to identify how they feel and how to cope in healthy ways.

References

Read more: http://www.livestrong.com/article/180006-how-is-sadness-healthy/#ixzz1rC1fjlcD

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Is Crying Healthy?

When emotions overtake you, crying can be a healthy emotional release. But not all environments are conducive to alleviating sadness or expressing relief.

Medically reviewed by Pat F. Bass III, MD, MPH

The notion that big boys or big girls don’t cry is a persistent idea fed by popular sayings, but psychologists and researchers say that it’s just not so. Shedding tears can be a huge and very healthy emotional release, particularly if you are experiencing deep pain, sadness, anger, or stress.

One study analyzed 140 years of popular articles about crying and found that more than 9 in 10 found tears to be a good way to release pent-up feelings. An international sample of men and women from 30 countries found that most reported feeling relief after a good cry. And about 70 percent of therapists say they believe crying is good for their patients.

Crying as Catharsis

The main benefit of crying is catharsis, or a purging or purification of your feelings through emotional release. When you cry, you can let go of the tension and sadness and other emotions that have been causing you pain. In many ways, crying serves as a safety valve that allows you to blow off emotions that have built up too much pressure inside you.

It’s been difficult for researchers to figure out how this works. When tears are induced in a laboratory setting — for example, having subjects watch a sad movie — more often than not the participants report that they feel worse rather than better.

Despite this, people consistently report that a good cry makes them feel better. One recent study reviewing more than 3,000 detailed reports of recent crying episodes found that most people reported an improvement in their mood afterward. Another study of 196 Dutch women found that nearly 9 in 10 said they felt better after crying.

Another benefit of crying is that it can bring people closer. An Israeli researcher studying the evolutionary aspects of crying has speculated that shedding tears communicates vulnerability to others, since the tears blur your vision and leaves you defenseless. A person who cares for you while you are in this weakened state can grow closer to you, and the bond between the two of you may grow stronger.

Have a Healthy Cry

Research has found that for crying to improve emotional health, certain conditions need to be met:

  • You should have a shoulder to cry on. People who receive social support while crying report more cathartic release than people who cry alone. Find a friend or loved one you trust.
  • You should cry after you’ve solved the problem. People feel better when they cry about a problem that’s already been resolved. If you cry before you’ve dealt with the situation that’s making you feel like crying, you are likely to receive no benefit or actually make yourself feel worse rather than better.
  • You need to make sure you’re crying in an appropriate place. People who experience shame or embarrassment while they cry are less likely to report an improvement of their mood. If you’re going to feel bad about crying in a public place or in front of certain people, you need to hold back your tears and go somewhere else.
  • Crying likely won’t help you if you are living with a mood disorder. People who live with clinical depression or anxiety disorders are less likely to feel better after they have a good cry. If you find yourself feeling worse after crying, you should see a doctor or therapist to see if you have a mood disorder.

But if you can’t stop the tears from falling, go ahead and let it all out — the odds are you’ll feel better afterward.

Brian Cuban Interviews Larry North about 11 Healthy Eating Myths

briancuban
A FEW TAKEAWAYS in case you missed it.  Brian Cuban asked Larry what it takes to be lean and some of his answers may surprise you.  
SHINE ON:  Foods for Healthy, Glowing Skin
If you think what you eat doesn’t matter, as long as you “work it off” –that’s a myth.  
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According to Larry North, eating healthy makes MORE of a difference than exercise.  Here are 11 Tips from Larry:
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1. You CAN get food, flavor & satisfaction in healthy meals.  Brian mentioned he doesn’t cook and eats out a lot.  Larry said he actually will call the local grocery store where they prepare take-out meals and have them cook/prepare healthy meals for him. Good suggestion.  He orders carefully when at a restaurant. He said  pieces of a cut roll & sashimi is enough.  He believes in eating a lot of good food. He says it’s all about eating. More about the food choices than exercise.
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2. #1 cause of obesity is sugary drinks. Best thing you can do is cut out sodas & sugary coffees out completely.  I’ve been saying this forever. I did so inn 2005 and feel such a difference.  I can personally tell you that your body starts to reject sugar and junk food.
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3. Genetics play a huge role, but HABITS play an even larger role.  Larry stressed that even if you have a lot of family members that are obese, you CAN make a difference by making behavioral changes.
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4. Cardio is overrated.  See #9.
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5. You CAN’T work it off. You have to eat it off (meaning WHAT you eat is more important)
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6. There’s ONE key to a good meal & fitness program. It’s SUSTAINABILITY. You have to ask yourself if you can stick with it long-term. If you can’t sustain it –it will be short-lived.
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7. Behavioral change is the key to fitness.
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8. Work out less; eat better. Larry kept stressing the importance of your food choices. I’m glad about this because I post a lot about healthy foods. I believe a lot of good health (feeling AND looking your best) is nutritional.
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9. 4 to 5 hours of exercise is enough a week.  Larry says if you’re doing more than that –it’s too much.  Brian mentioned that he loves running, but had a problem with his knee and really hates that he can’t run.  Larry said he could get the same benefits from walking –that he doesn’t need to run.
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10. It’s all about what you eat. Plan meals in advance. Larry has two books you can check out. One is “Get Fit” and the most recent is “Living Lean“.
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11.  I missed one.  It’s probably in the book!!  🙂  Wait. I recall another one.   I suppose I should write things down.  Lifting weights. He says you don’t have to spend a great deal of time lifting weights to have it make a difference.  Again, he stresses what you eat as being the most important behavior change you can make.  30 to 40 minutes of even walking 4 days a week keeps you fit when you are eating right.
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The bottom line is you do not need to be a gym rat.
CHECK OUT LARRY NORTH’S BOOK FOR MORE:
THANK YOU, BRIAN. GREAT INTERVIEW.
Link to Revolution Rant with Brian Cuban Show here:   http://tobtr.com/s/3052629.
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Stay healthy, everyone!

Spotlight on Alzheimer’s

This morning, I step outside and feel a familiar cold chill –reminiscent of pre-sunrise in San Diego.  Later, I glance out window. Sunshine hides like my favorite red augyle sock after laundry.

Gloomy skies get me thinking about Seasonal Affective Disorder and what new therapies exist.

People generally talk about S.A.D. (pun!) when Fall arrives.  What about cloudy days in Spring?  I’ve never been diagnosed with S.A.D., but I’m a bit of a hypocondriac.  I know.  Ironic.

Other people get to benefit from it. In the past, doctors. They laugh and say I’m the healthiest person they’ve ever seen.  I get sent home with a lollipop.  And a bill.

Friends and relatives benefit because each time I think I have something, I put my glasses on and do extensive research.  Lightning speed.  I don’t need eyeglasses anymore (thank you, Dr. Bell of The San Diego Eye Institute).  Research Ninja at your service.

Ever since I was a little kid, my cousin Josephine and I loved researching our imagined illnesses. We loved  using big medical words too.  Some words made us crack up.  Today, Josephine is a top pediatric nurse and I’m the health journalist ninja.

Anyhow, this morning, while I’m researching light therapy for Seasonal Affective Disorder, I find a blog about using the same Light Therapy for Alzheimer’s patients.  Never heard of THAT.

It’s written by a caregiver named Gary LeBlanc.

I contact Gary & ask for permission to share his blog. I thought it would help other people. He says yes.  (Don’t worry, I get back to light therapy options for Seasonal Affective Disorder later)

I thank Gary for allowing me to repost his unique experience utilizing light to care for his father with Alzheimer’s disease. I always trust real people sharing their medical experiences, rather than professionals.  I have to read between the lines with the latter. Who is funding them? What’s the agenda? Are they PR flacks?  When it’s real people –there is no agenda.

Gary was the primary caregiver of his father for a decade after he was diagnosed with Alzheimer’s disease. Gary has a book, but it is one based on his experience.  It’s called, “Staying Afloat in a Sea of Forgetfulness.”

I notice his article got 7 clicks.  Since I have over 1.2 million people within my social network, and most work in NATIONAL MEDIA and MEDICAL –I thought I’d share his story and shed some LIGHT on something a lot of other Americans are dealing with right now.   It’s so cool when something little –something you can DO can make a big difference. Gary explains.

Light therapy lessens hardships

By GARY LEBLANC | Common Sense Caregiving
Published: March 22, 2012 Updated: March 22, 2012 – 12:00 AM
For many years now I have preached how beneficial it is to keep the homes of those suffering from Alzheimer’s Disease well lit. Throughout my father’s illness I kept the lights on at full tilt in both the bedroom and bathroom throughout the night. By doing so it kept him from experiencing mass confusion during his frequent bathroom runs in the wee hours.

Even during the daylight hours he had trouble crossing the threshold into the bathroom. The difference from one room’s carpet turning into tiles had him believing there was a step, making him raise his foot high, stepping over nothing. Color contrast can become very deceiving.

A friend of mine, who cares for her father-in-law with Alzheimer’s, recently told me that when she takes him to his doctor’s office, there’s a black welcome mat that scares him to pieces. He refuses to walk on it because he believes it’s a deep hole.

As caregivers we must keep things as simple and safe as possible for our loved ones. Paying close attention to their habits is a good way to start.

For those experiencing Sundowners, also known as “Sundown Syndrome,” start lighting up the house a good hour before dusk. By preventing shadows from creeping in, this will take away some of the hardships experienced during that time of day. Researchers have even found that by using the correct color temperature light bulbs may have a positive effect on mood and behavior.

For instance, what is perceived to be cool-white light has been reported to help the patients remain more alert and verbally active. On the other hand, warm-white light, which has more of a reddish-yellow tinge to it, is said to keep the patient calmer, helping to temper behavior problems.

Unfortunately, visual perception becomes altered from Alzheimer’s. A good tip to keep in mind is to always consider the color contrast in all situations. If you’re having problems getting patients to eat, take into account the way in which the table is set. A white plate on a white table cloth may be very difficult for them to see. Think “Bold Colors.” Try placing their food on a red plate. Even when it comes to the silverware, bright colored handles may encourage them to start digging in. A recent study has found this method has increased intake by 25 percent.

Let’s say there’s a clear glass of water on a white table; change it to a blue cup. This will help them to visually recognize it easier, actually encouraging them to pick it up and drink from it, preventing dehydration. How important is that?

Gary Joseph LeBlanc can be reached at us41books@bellsouth.net. A new expanded edition of his book, “Staying Afloat in a Sea of Forgetfulness,” can be found at stayingafloatbook.com, Amazon or Barnes and Noble.

Here’s little refresher for anyone who isn’t aware of Alzheimer’s statistics:

Right now, 15 million Americans serve as caregivers, and this is projected to rise to 45 million by 2050.  I got that from The Alzheimer’s Association.

1 in 8 older Americans has Alzheimer’s Disease and 1 in 7 lives alone.  So, there’s all this cheerleading going on about “Living Longer” but are we living Healthier?

According to Psychiatric Times, as many as 50% of persons older than 85 years have some form of dementia (Alzhemier’s disease being the cause in at least two-thirds of cases).

Psychosis occurs in approx. 40% of persons with Alzheimer’s disease, and agitation occurs in 80% or more of persons with dementia at some point.  The photo below on the left is what a normal brain looks like. The middle brain shows mild cognitive impairment. The one on the far right is Alzheimeer’s Diseasse.

When I first saw this photo this morning, I wondered why they can’t track the progression on MRI scans, and then a new study popped up saying researchers discovered they can do just that.  News story below.

A study in March 22 issue of the Journal, Neuron says Alzheimer’s disease and other forms of dementia may spread within nerve networks in the brain by moving directly betweenn connected neurons. They’re thinking an MRI could track the progression of it.

This makes absolute sense and I wonder why they didn’t have this A ha! moment sooner. I was also looking at photos of the brain this morning and photos of the brain without Alzheimer’s and with are remarkably different, so I had the same thought. Why can’t doctors track the progression with a brain scan.

I’d LOVE to know how to PREVENT dementia and Alzheimer’s Disease. Something is causing it in so many Americans. My first instinct tells me it is related to NUTRITION.   Something people are eating or drinking is eroding brain cells. Is it soda? Did you see how when someone said they found a mouse in their soda and tried to sue the soda company –the soda executive’s defense was that it was “impossibe” because the mouse would have dissolved in the soda?  Wow.  If it can erode an entire mouse imagine what it can do to your brain.  I could almost hear the fizzling sound of brain cells.  Until we discover how to prevent it, I am always on the lookout for anything that can help patients, families and caregivers.

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Consequently, my dear friend, Dr. Max Gomez from CBS just lost his father to Alzheimer’s.   Sympathies go out to the Gomez family at this time.  If you’d like to reach out, here’s a note from Max:

“Some folks have asked about flowers… please don’t. If you’re inclined, I’d much rather you send a donation in my father’s name, Dr Max Gomez, Sr., to the Alzheimer’s research group at NYU where they diagnosed and cared for Dad; check should be made out to the NYU Center for Brain Health and sent to:  Center for Brain Health, NYU School of Medicine, Dept. of Psychiatry, 145 E. 32 St., 5th fl, New York, NY 10016.  Attn: Dr. Mony DeLeon. They will also supply tax receipts. Thank you for your thoughts and prayers.”

 

Natural sunlight is always preferable, but LIGHT THERAPY is fascinating in that it can help with the following:

Migraine Headache

LET’S TAKE A LOOK AT  WHERE YOU CAN GET LIGHT THERAPY, PRICES along with REVIEWS from HEALTHYLIVING.COM:

Phillips GoLight BLU

Light Therapy On The Go

Philips goLITE BLU Light Therapy Device

Philips goLITE BLU Light Therapy Device

Amazon Price: $119.95 (as of 03/22/2012)Buy Now

Some researchers and light therapy users believe that blue light is the most important part of the spectrum for treating SAD. The Phillips GoLite BLUE is compact, portable, and operates on a rechargeable battery. It’s easy to bring it and use it almost anywhere. 

Syrcadian Blue Light Therapy Device for SAD

Light therapy for your morning commute

The Syrcadian Blue Light Therapy Device comes with a USB cable to mount on a laptop screen. There’s also a car adapter kit to mount on the visor of a car. With the lamp itself, plus the car adapter set, it costs around $100.
Syrcadian Blue SB-1000 Sad Light Therapy Device

Syrcadian Blue SB-1000 Sad Light Therapy Device

Amazon Price: $59.95 (as of 03/22/2012)Buy Now

This handy device is tiny, inexpensive, and very portable. You can mount on the top of your computer monitor, where it draws power vis USB cable, or plug it into your car’s cigarette lighter and mount it on the visor — you can commute and get your light therapy in at the same time. Two brightness settings allow you to select the amount of light you want.

  

Accessories for the Syrcadain Blue

Use it in your car; charge it from a wall socket

The Syrcadian Blue comes with a USB cable, enabling you to plug it into your computer’s USB port, mount it on top, and get your therapy while you work. But that’s not your only option.
Syrcadian Blue Automotive Adapter

Syrcadian Blue Automotive Adapter

This kit provides clips to attach the Syrcadian Blue to your visor, and a car charger to power the device. Use your morning commute to get your light therapy.

Amazon Price: $29.95 (as of 03/22/2012) Buy Now

Syrcadian Blue Wall Mount Power Supply

Syrcadian Blue Wall Mount Power Supply

Multi-country adapters to plug your Syrcadian Blue into a wall outlet.

Amazon Price: $24.95 (as of 03/22/2012) Buy Now

  

Other Portable Light Therapy Lamps for SAD

Bring your light therapy with you!

Having the option of taking your therapy lamp wherever you go can alleviate the frustration of living with seasonal depression. Below are more options for portable, lightweight light therapy for seasonal affective disorder. All devices listed have received an average rating of 4.5 to 5 stars on Amazon.
Philips Hf3321/60 Golite, White / Blue

Philips Hf3321/60 Golite, White / Blue

If entirely blue light is too intense for you, Phillips offers a therapy device that’s half blue light and half white light. It features the same low weight and compact dimensions as the GoLite Blu.

Amazon Price: $78.73 (as of 03/22/2012) Buy Now

Litebook Elite Hand-Held Light Therapy Device

Litebook Elite Hand-Held Light Therapy Device

The Litebook Elite runs on a long-lasting rechargeable battery. It features a custom lens to provide a uniform field of full spectrum light.

Amazon Price: $168.95 (as of 03/22/2012) Buy Now

Sphere Gadget Technologies SP9882 Lightphoria Sad Light Therapy, 10,000 Lux

Sphere Gadget Technologies SP9882 Lightphoria Sad Light Therapy, 10,000 Lux

This portable plug-in sunlamp offers three intensity settings: 5,000 lux, 8,000 lux, and 10,000 lux. It comes with its own travel pouch so you can bring it anywhere.

Amazon Price: $99.99 (as of 03/22/2012) Buy Now

NEW Bio Brite Lumie Zip Portable Light Lite Therapy Box

NEW Bio Brite Lumie Zip Portable Light Lite Therapy Box

Another portable sunlamp, only this one works on batteries. Coming in at 2,500 lux, it’s a good choice for those who experience eyestrain or headaches with higher lux, or who would like to double it up as a task lamp for longer periods of time.

Amazon Price: $199.00 (as of 03/22/2012) Buy Now

Feel Bright Light Visor

Feel Bright Light Visor

This light therapy visor will be the next therapy device I try. It works on a rechargeable lithium battery and emits 10,000 lux of blue-green light. A visor is included in the package, as well as clips to attach to your favorite baseball cap.

Amazon Price: $217.00 (as of 03/22/2012) Buy Now

Important!

An Important Fact Light Therapy and Bipolar Disorder

A lot of people with bipolar disorder have seasonal mood problems. However, light therapy can cause hypomania or manic episodes in people with bipolar disorder. This is especially true with blue light therapy. If you have bipolar, DO NOT use light therapy unless it’s under close supervision by your doctor.

Phillips Dawn and Dusk Simulator

Sunrise and sunset, exactly when you want them.

A “dawn simulator” is a large, bright white light that serves as an alarm clock. Say you set your alarm for 8 a.m.; the light in the dawn simulator will start to come on gradually, starting around 7:30 or so, and reaching full brightness at 8. You wake up gradually and naturally. It feels much better than being startled awake by an alarm clock.Since my home has skylights, I don’t need to use the “dawn” feature, but I love the “dusk” feature. One reason I don’t get enough sleep is that I like to read in bed, and no matter how tired I am, I can easily lose myself in a book. Before I know it, it’s 4 a.m. The dusk simulator allows me to set a timer for up to 15 to 90 minutes, and as that time passes, its light will slowly dim. Eventually I can’t see my book anymore, which makes it easier for me to put my book down and go to sleep.
Philips HF3471/60 Wake-Up Light, White

Philips HF3471/60 Wake-Up Light, White

Amazon Price: $84.95 (as of 03/22/2012)Buy Now

The Phillips Dawn and Dusk Simulator allows you to wake up with the dawn, whatever the actual time might be. At night, use a timer so that the light dims slowly, triggering your body’s natural sleep process. The alarm also has some pretty nice sound options, such as birdsong — much nicer than a buzzing, jangling alarm clock.

Wake-up Lights for SAD Therapy from Amazon

Dawn simulators help you sleep and help you wake up.

Dawn simulators increase the light in your bedroom gradually and naturally. The artificial “sunrise” this provides can be especially helpful if you have to wake up when it’s still dark out.
EZ Wake Digital SunRise Alarm Clock - Sea Green

EZ Wake Digital SunRise Alarm Clock – Sea Green

Amazon Price: $89.95 (as of 03/22/2012) Buy Now

BioBrite Sunrise Clock Advanced Model  Charcoal

BioBrite Sunrise Clock Advanced Model Charcoal

Amazon Price: $100.00 (as of 03/22/2012) Buy Now

Natural Dawn Simulator Alarm Clock Light Box

Amazon Price: $165.00 (as of 03/22/2012) Buy Now

Sunrise SRS 260 Sun Simulator Alarm Clock MP3 Player

Sunrise SRS 260 Sun Simulator Alarm Clock MP3 Player

Amazon Price: $169.95 (as of 03/22/2012) Buy Now

Important!

Side Effects of Light Therapy

Compared to medication, light therapy has very few side effects. They include headache, nausea, irritability, eye strain or dry mouth. These symptoms often go away on their own, or they can be mitigated by changing the angle of the lamp, its brightness, or duration of the therapy.

For More Reviews Visit:

Light Therapy Reviews

Stay Healthy, everyone!  🙂

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Treatment of Insomnia in Anxiety Disorders

by Gregory M. Asnis, MD, Elishka Caneva, MD, and Margaret A. Henderson, MD
Insomnia is highly prevalent in psychiatric disorders, and it has significant implications.

This review focuses on insomnia in the context of anxiety disorders. The prevalence of comorbid insomnia in anxiety disorders is addressed and the clinical implications associated with insomnia are discussed as well as when and how to treat this important comorbidity.

Just how specifically insomnia relates to and possibly affects anxiety disorders is highlighted by the fact that insomnia is one of the defining criteria in a number of the DSM-IV-TR anxiety disorders.

For example, difficulty in falling or staying asleep is a criterion for PTSD, acute stress disorder, and generalized anxiety disorder (GAD).

The relationship of insomnia to anxiety disorders is also influenced by comorbid major depression. The severity of insomnia is increased when an anxiety disorder is comorbid with a major depressive disorder (MDD).1 This is highly relevant because 58% of MDD patients have a lifetime anxiety disorder.2

The presence of insomnia has a deleterious effect on daytime functioning and negative effects on quality of life, including social and work relationships.3

Insomnia (1997 film)
Image via Wikipedia

Also, there is clear evidence that the presence of insomnia in anxiety disorders is associated with increased morbidity.

For example, in patients with PTSD, insomnia is associated with an increased likelihood of suicidal behavior, depression, and substance abuse as well as nonresponsiveness to treatment.4-6

In addition, insomnia as an early symptom in traumatized patients increases the risk of the development of PTSD 1 year later.7

Early assessment

It is important to carefully assess for insomnia early in the evaluation of patients with anxiety disorders and to aggressively treat this complicating comorbidity.

Insomnia is an underrecognized and undertreated problem. Patients rarely report their symptoms of insomnia spontaneously to their doctor. Adding to the problem of detecting insomnia is the finding that doctors rarely inquire about insomnia in their patients.3,8,9

 Thus, a carefully taken history is an important first step in the assessment of insomnia.

Self-rating sleep questionnaires and direct clinical interviews are used to obtain a history of potential sleep disorders (eg, insomnia). A number of well-validated sleep questionnaires have been widely used.

The most widely used and validated questionnaire is the 19-question Pittsburg Sleep Quality Index. The questions cover sleep quality, sleep problems, sleep medications, and so on, within the past month.10

Another widely used questionnaire is the Leeds Sleep Evaluation Questionnaire (LSEQ). The LSEQ consists of 10 self-rating questions that cover sleep and aberrant sleep behaviors.11

Besides self-rating questionnaires that depend on memory of sleep disturbances, a sleep log or diary can confirm questionable sleep disturbances prospectively.

The use of a sleep log allows for an analysis of day-to-day sleep patterns, such as the time that the patient went to bed, sleep latency, and nighttime awakenings.8,9 The log is filled out by the patient shortly after awakening in the morning (see Morin9(p38) for an example of a sleep log). If at all possible, monitoring for up to 2 weeks is highly recommended because it allows for sleep abnormalities that might show marked day-to-day variability and would more likely be detected by extensive monitoring.12,13

What is already known about insomnia
in patients with anxiety disorder?
No Me Mireis!

■ Anxiety disorders frequently coexist with insomnia. The latter is believed to be part and parcel of various anxiety disorders and is one of the defining criteria of a number of them.

What new information does this article provide?

■ Our article clarifies new approaches to considering insomnia in anxiety disorders. The presence of insomnia should be considered a comorbid illness and treated on its own. Pharmacotherapy, cognitive-behavioral therapy, and a combination of both are discussed.

Insomnia is an added pathology that brings increased morbidity to patients with anxiety disorders. Our review suggests that successful treatment of insomnia actually increases the responsiveness of anxiety disorders to many antianxiety treatments.

What are the implications for psychiatric practice?

■ When evaluating patients with anxiety disorders, psychiatrists should carefully evaluate for the presence of insomnia. Patients infrequently bring up this symptom on their own. If insomnia is present, aggressive treatment early in the course of therapy is highly suggested.

If the presence of insomnia is suspected, interviewing a spouse, a significant other, or a caregiver is helpful. Some patients who believe they have insomnia symptoms appear to have “sleep state misperception,” where their partners clearly state that their sleep is normal.14

These “others” can also report problems that are likely not obvious to the patient:

• Apnea spells or excessive snoring as seen in obstructive apnea

• Excessive body movements as seen in periodic leg movement disorder and restless legs syndrome

• Various sleep-related behaviors (sometimes violent and aggressive) as seen in rapid eye movement behavior disorder (RBD)

• Sleepwalking

Referral to a sleep specialist and sleep polysomnography has been recommended if pharmacological or nonpharmacological options are not working. Referral is also warranted for patients with insomnia in whom a specific sleep disorder, such as obstructive sleep apnea, periodic limb movements, narcolepsy, or RBD, is suspected.12,15

Even when a visit to a sleep laboratory is suggested, the cost of an overnight visit is often prohibitive—more than $1000 per night; usually 2 nights are required with the first being an adaptation night for the patient. Insurance frequently does not cover these costs.16

If it is found that the patient has sleep apnea, a sleep movement disorder, RBD, or a number of other sleep disorders, specific nonhypnotic treatments may be required (eg, continuous positive airway pressure for sleep apnea is the treatment of choice).

Before beginning treatment of anxiety disorder–associated insomnia symptoms, rule out any concurrent medical illness, medication treatment, or substance use that might be inducing or worsening insomnia. Many medical illnesses, such as cardiovascular disorders (eg, congestive heart failure), pulmonary disorders (eg, emphysema), endocrinopathies (eg, thyroid disorders), GI disorders (eg, acid reflux), and neurological disorders (eg, pain syndromes), are associated with insomnia.12

Carefully assess the use of medications for medical and psychiatric disorders that may be implicated in insomnia as well as caffeine(Drug information on caffeine) or alcohol(Drug information on alcohol) use. Even small amounts of the latter have been associated with increased nighttime awakenings.

Insomnia
Image by EasyPickle via Flickr

Before providing any significant intervention for insomnia, a careful evaluation regarding behaviors that might contribute to insomnia should be made.

Daytime naps, late nighttime snacks or meals, watching television in bed, nighttime exercise, or excessive light or loudness in the bedroom should be identified and modified. Eliminating these behaviors can lead to significant sleep improvements. A 13-item self-rating questionnaire by Mastin and colleagues17 can help elicit sleep hygiene information.

Pharmacological options

The treatment of insomnia in patients with anxiety disorders is, for the most part, the same as the treatment of insomnia per se: pharmacological, nonpharmacological, or a combination of the two.

The primary treatment of insomnia is pharmacological because of the rapid onset of action (eg, hypnotics are usually effective within days to 1 week of use). The most common nonpharmacotherapy, cognitive-behavioral therapy for insomnia (CBT-I) takes considerably longer.3,8,12 Currently, the FDA has 11 approved drugs for the treatment of insomnia:

• Nonbenzodiazepines: eszopiclone, zolpidem(Drug information on zolpidem), zolpidem ER, and zaleplon(Drug information on zaleplon)

• Benzodiazepines: estazolam, flurazepam(Drug information on flurazepam), quazepam, temazepam, and triazolam

• A tricylic antidepressant: low-dose sinequan

• A melatonin(Drug information on melatonin) agonist: ramelteon

In recent years, nonbenzodiazepines have become the most recommended of the approved hypnotics. (There has been less and less reliance on benzodiazepines.) Not only are nonbenzodiazepines effective in treating insomnia (equivalent to the benzodiazepines), but there is a notion that they are safer than benzodiazepines.3,12

Both nonbenzodiazepines and benzodiazepines are associated with adverse effects that include fatigue, dizziness, ataxia, and the development of dependence and tolerance with long-term use. Although head-to-head studies comparing these classes of hypnotics have been minimal, a recent meta-analysis supports the finding of reduced adverse effects for the nonbenzodiazepines.18 The nonbenzodiazepines typically have a shorter half-life and are more selective at the γ-aminobutyric acid receptor, factors that are partially responsible for less residual daytime sedation and other adverse effects.

In the treatment of anxiety disorders with comorbid insomnia, the latter should be treated concurrently with, but independently of, the anxiety disorder per se. The idea that one should wait to see whether the insomnia resolves with only the treatment of the anxiety disorder is no longer valid. Clinical experience has shown that without targeted insomnia treatment, insomnia frequently persists.3,19

When adding a hypnotic to an antidepressant in the treatment of anxiety, the risk to benefit ratio must be considered. Pollack and colleagues20 looked at a large group of patients with GAD comorbid with insomnia (N = 595). The patients received either 10 mg of escitalopram(Drug information on escitalopram) coadministered with 3 mg of eszopiclone or the escitalopram with placebo. Those in the active hypnotic treatment group had a significant response in their insomnia by the first week. The combination of medications was well tolerated with no significant increase in adverse effects.

Most surprisingly, the anxiety scores for those patients who received the hypnotic significantly improved starting at week 4 even after removing insomnia symptoms from the anxiety assessment. The time to onset of the anxiolytic response was also reduced. In addition, the combination treatment led to a slightly better symptom response and remission rate for the anxiety disorder.

Similar results were reported in a 12-week open-label study (N = 27) undertaken by Gross and colleagues.21 The researchers evaluated ramelteon (8 mg/d), a melatonin agonist, in patients who had GAD comorbid with insomnia and whose condition was partially responsive to an SSRI or a serotonin norepinephrine(Drug information on norepinephrine) reuptake inhibitor. The hypnotic was well tolerated, effective for insomnia, and appeared to facilitate the treatment of GAD.

A double-blind placebo-controlled study by Fava and colleagues22 evaluated the efficacy and safety of zolpidem(Drug information on zolpidem) extended-release (12.5 mg/d) versus placebo in patients with comorbid GAD and insomnia who were being treated with escitalopram (10 mg/d). Sleep measures improved significantly by the end of week 1, and there was no added burden of adverse effects. Zolpidem did not show a beneficial anxiolytic effect.

Approximately 50% of patients with insomnia continue to have insomnia 3 years after initial diagnosis, and many patients require months to years of treatment. Nonbenzodiazepines for primary insomnia were found to have continued efficacy and to be well tolerated with no evidence of abuse or withdrawal symptoms on discontinuation of use after 12 months.23,24 Ramelteon was also found to be efficacious with no significant issues of abuse or tolerance in a 24-week open-label study.25 The literature for longer use of hypnotics is scarce.

Anxiety disorders are frequently comorbid with alcohol(Drug information on alcohol) or substance use disorders.4,26 Consider ramelteon or low-dose sinequan to avoid potential issues of abuse and addiction. Nonbenzodiazepines are preferred over benzodiazepines; there is evidence that the former have decreased potential for abuse and a better adverse-effect profile.

In some patients with insomnia, benzodiazepines are clearly necessary. The other hypnotics may not be as effective for some patients, and the anxiolytic properties of benzodiazepines may be helpful.

When hypnotics are used (particularly, benzodiazepines and nonbenzodiazepines), their use should be reassessed—every 3 to 4 weeks.3,12 Many patients with insomnia do not experience sleep disturbances nightly. Therefore, the use of hypnotics on an as-needed basis or a few times a week helps cut down on the amount and exposure to medication.27

Trazodone and mirtazapine(Drug information on mirtazapine) are also widely used for insomnia, as are atypical antipsychotics and herbal preparations. Unfortunately, these agents have not been rigorously studied for insomnia and thus their effectiveness and safety remain unclear.3

Nonpharmacological interventions

CBT-I is an important, widely accepted, multimodal treatment for insomnia and the best-studied of the nonpharmacological approaches for this disorder.

It is a manualized treatment that focuses on various components of CBT (ie, cognitive restructuring and the use of psychological interventions, such as the practice of good sleep hygiene, stimulus control, sleep restriction, and relaxation therapy).

These methods address negative and distorted cognitions and behaviors that initiate and perpetuate insomnia.9,28 Treatment duration is relatively short. It is administered for 5 hours divided over 4 to 6 weeks and can subsequently be used as a maintenance treatment in monthly sessions. There are approximately 12 well-designed CBT-I trials that have clearly demonstrated that it is a highly effective intervention for insomnia for 1 year or longer.29,30

Studies that compared CBT-I with pharmacotherapy found equivalent efficacy.31 This has led the NIH Consensus and State of the Science Statement to conclude that CBT-I is “as effective as prescription medications are for short-term treatment of chronic insomnia. Moreover, there are indications that the beneficial effects of CBT, in contrast to those produced by medications, may last well beyond the termination of active treatment.”3 In contrast to hypnotics, learned CBT-I skills may persist even when active treatment ends.9 Furthermore, some patients may prefer CBT-I over hypnotic drugs because of their possible adverse effects or because of concerns about drug interactions or taking a drug during pregnancy.9

In general, CBT-I is underutilized—only about 1% of patients with chronic insomnia receive this therapy.32 To increase the availability of CBT, it can be administered via self-help strategies (eg, educational books and materials) and in group formats. In addition, the use of the Internet to provide CBT has been shown to be effective. Nonetheless, patients frequently prefer face-to-face contact.33

Besides CBT-I, a number of other nonpharmacological therapies, such as bright light, physical exercise, acupuncture, tai chi, and yoga, have been used to treat insomnia. Unfortunately, the results have been inconsistent.32,34

Combination therapy

  • Is a combination of pharmacotherapy and nonpharmacotherapy more effective than either alone in the treatment of anxiety disorders with insomnia? Combination therapy has not been addressed in studies of this particular patient population. Furthermore, the question has been minimally addressed even in the treatment of insomnia per se.
    Study findings suggest only modest differences in outcomes with a combination of therapies. Similar results were seen in a study that compared CBT with CBT pluszolpidem(Drug information on zolpidem). The 6-week acute study demonstrated a 60% response rate and a 40% remission rate; the group with the combination treatment did have a significant increase in sleep time of 15 minutes, but the researchers question the clinical significance of this isolated finding.29

Summary

Anxiety disorders with comorbid insomnia are highly prevalent with potential negative consequences. Therefore, assess for insomnia with self-rating scales and careful clinical interviews. When appropriate, refer patients for polysomnography.

Insomnia should be treated aggressively with pharmacotherapy, nonpharmacotherapy (particularly CBT-I), or a combination. Some of the hypnotic treatments actually appear to facilitate successful therapy for the anxiety disorder.

Benzodiazepines and nonbenzodiazepines have a number of adverse effects and can lead to abuse and dependence. Patients with an anxiety disorder may be particularly vulnerable, especially those with a history of alcohol(Drug information on alcohol) and drug abuse. Treatment with benzodiazepine and nonbenzodiazepine hypnotics needs to be reassessed monthly. Alternatively, ramelteon, low-dose sinequan, and CBT-I should be considered because they have minimal adverse effects and no risk of abuse.

Successful treatment of insomnia is an important goal in patients with anxiety disorders. Both pharmacological and nonpharmacological interventions have response rates of approximately 60%.

ABOUT THE AUTHORS:  Dr Asnis is Professor in the department of psychiatry and behavioral sciences at the Albert Einstein College of Medicine and Director of the Anxiety and Depression Clinic of Montefiore Medical Center, Bronx, NY; Dr Caneva is a Psychiatry Fellow at the Anxiety and Depression Clinic of Montefiore Medical Center; Dr Henderson is Research Coordina-tor at the Anxiety and Depression Clinic of Montefiore Medical Center. Dr Asnis is Consultant for Bristol-Myers Squibb and has received grants in the past year from Forest Pharmaceuticals, Lilly, Otsuka, and Pfizer. Drs Caneva and Henderson report no conflicts of interest concerning the subject matter of this article.
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