Education Update - July 2002

JULY 2002 ■ EDUCATION UPDATE ■ MEDICAL UPDATE13Risky Teen BehaviorDepression in TeenagersBy RICHARD FRANCES, M.D.Early detection and treatment of major psychiatricdisorders that afflict young people,including addiction, depression, bipolar disorder,anxiety disorder, attention deficit disorder,and schizophrenia can be the best way to preventthe serious consequences of mental illness,including suicide.Teenage suicide has doubled in the last 20years and 70 percent of suicides among youngpeople involve chemical abuse or dependence.Normal youngsters rarely attempt or succeed insuicide, and most suicides are associated withtreatable psychiatric conditions includingaddiction. Parents, teachers and peers need towatch for signs of low self-esteem, hopelessness,social isolation, smoldering anger, cripplingsadness and anxiety, use and abuse ofalcohol, marijuana and other drugs, impulsivity,poor judgment, and poor communicationwith family, peers and teachers.Screening and early treatment for psychiatricproblems helps prevent the progression andworsening of conditions that can lead up to disaster.Other important signs include a positivefamily history of major illnesses, includingaddiction, depression, bipolar illness, anxietydisorders, and suicide. Watch for signs of theseproblems in first degree relatives, includingsiblings. Most of the major psychiatric illnessesbegin in the teenage and young adult years,and the earlier they are detected and treated, thebetter the result. A variety of cognitive behavioraland psychodynamic treatments are availableand are most effective when combinedwith medications in the treatment of these disorders.For young people with substance abuseand additional psychiatric diagnosis, it is crucialto make sure that both diagnoses are welltreated and that the individual is substance freewhile engaged in medication treatment andpsychotherapy.By HARVEY K. FRIEDLAND,J.D., B.E.E.It started with a twitch in one of my fingers. Itpulsated then quickly abated. For reasons thenbeyond my comprehension, it started again.This is what I told my physician half a decadeago. She immediately told me “You haveParkinson’s disease. I’ll make an appointmentDO YOUHAVE ASTHMA?Volunteers NeededFor Asthma Study.Harlem Hospital & ColumbiaUniversityAre Studying WaysTo ImproveThe Treatments Of AsthmaAt No Costs To YouYou Can EarnUp to $1100 For ParticipatingFor Information Please Call:212-939-8360Twelve step, peer led and group, family andnetwork therapy techniques can be very helpfulin working with this age group. An especiallycritical time is the adolescent’s first year awayfrom home at college with its often concomitantincrease in substance use and decrease inparental presence. One example of a psychiatricillness that has a 15 percent mortalityrelated to suicide is manic depressive disorderwhich can be effectively treated with lithiumand mood stabilizers, and which is frequentlyassociated with alcohol and drug problems.Both problems must be successfully treated toavoid the roller coaster ride of relapse. Welltreated individuals with this disorder can go onto productive lives and are often among ourmost creative and effective people. Undetectedor untreated bipolar illness leads to enormoussuffering in patients and their families. Somecharacteristics for evaluating suicide riskinclude presence of suicidal or homicidalideation, intent or plans; access to means forsuicide and the lethality of those means; presenceof command hallucinations, other psychoticsymptoms or severe anxiety; presence ofalcohol or substance use, history and seriousnessof previous attempts and family history ofor recent exposure to suicide. Abuse of substancesincreases impulsivity and worsensjudgment which can add fuel to self-destructiveimpulses.It is important that schools, parents and themental health community work closely togetherto provide better screening, detection andpreventative treatment for major psychiatric illnesses.This will lead to reduction of the devastatingeffects of suicide on family, schools andcommunity. #Dr. Richard Frances is President andMedical Director of Silver Hill Hospital in NewCanaan, Connecticut.with our neurologist, a young physician whowent to Harvard Medical School. He’ll examineyou, perform exclusionary tests, make an officialdetermination and put you on a schedule formedication. Okay?”It’s now four years later. I’ve been on the usualParkinson’s medications–Elderpryl and L-dopa.I recently entered the advanced stage ofParkinson’s, which means that those hours of theday when I become rigid and lethargic are arrivingat increasing intervals. During the cherished“on” times, when the medication is working theway it’s intended, PD sufferers such as myselffeel normal and energetic, but these hours dwindleto mere moments and become more elusiveand fleeting as the disease progresses and thebody deteriorates. New symptoms have startedoccurring; I’ve now found myself plagued withAttention Women21 - 28 Years OldLooking to earn extra income.Help a loving couple have a baby.Become an Egg DonorCharacteristics:Attractive, Caucasian, Brunette, Big Brownor Hazel eyes. Small or Medium boned.105 - 125 Lbs.Intelligent, Compassionate anda Good Temperament/Personality.Excellent CompensationFor More Info:E-mail: Gratefulwomen@aol.comCall: 917-747-5016Choices: Perspectives of a Patient With Parkinson’s Diseaseshuffling, dizziness and intermittent loss ofequilibrium.When I was first diagnosed with PD, I read atremendous amount about the disease. As Ifamiliarized myself with PD by following cutting-edgeresearch, attending lectures (such asthose given by Dr. Jeff Bronstein, Director ofMotion Disorders at UCLA) and going to supportgroups, I found that: there are really only afew options available to the Parkinson’s sufferer.A patient can opt to take medication and letthe disease take its ineluctable toll on his body,or he can elect to have DBS – Deep BrainStimulation – a serious surgical procedure thathas shown promising results but is still a far cryfrom a cure. DBS only lessens certain symptoms(such as tremor) and still requires somepatients to maintain their regimen of drugs.Also, DBS sometimes requires patients toundergo the procedure more than once.There is a third choice – a third hope – on thehorizon. “Spheramine”, a procedure not yetauthorized by the FDA (but on the fast-track forapproval and granted funds by the NationalInstitute of Health), utilizes cell-coated microcarriers(CCM) to inject human retinal pigmentedepithelial cells into a person’s brain sothat a patient can begin regenerating thedopamine-producing cells that have been dyingsince he began suffering from Parkinson’s. Ifand when approved by the FDA, spheramineoffers the best hope to patients such as myself,since it is a site-specific, minimally invasiveprocedure and has the potential of emancipatingthe PD sufferer from both his symptomsand his dependence on side-effect causingBy GLENN S. HIRSCH, M.D.Adolescence and the beginning of adulthoodis a developmental phase burdened with stressfulevents: high school, starting college, pursuingcareer goals, forming relationships withfriends and significant others, coping withchanging family roles. These stresses can precipitatelife-threatening illnesses and behaviorssuch as depression, anxiety disorders, substanceabuse, eating disorders and even suicide.Schizophrenia and bipolar disorder often havetheir onset during this time.During adolescence there is a rapid increase inthe number of youngsters who suffer fromdepressive illness and have suicidal thoughts.Several studies indicate that up to 8.3 percent ofadolescents suffer from depression, 20 percentof America’s teens have had thoughts about endingtheir lives and suicide is the third leadingcause of death among teens and young adults.The most important risk factor in teenage suicideis having a psychiatric illness. About halfof youngsters who kill themselves have adepressive disorder. Other disorders that placeteens at high risk include aggression, behavioraldisorders and substance abuse.While twice as many girls attempt suicide asboys, boys are more than ten times as likely tokill themselves. This difference appears to bemainly due to the method used. Girls tend tooverdose with pills which is often less lethalthan the use of guns which has been implicatedin more than sixty percent of teen suicides.Since depressive disorders are implicated inthe majority of teen suicides, an importantpathway to preventing suicide is the identificationand treatment of mood disorders. Some ofthe signs that a teen or young adult is sufferingfrom depression include: persistent sadness,irritability or boredom, complaints that nothingis enjoyable or a decrease in interest in activitiesor peers, sleep or appetite changes, difficultyconcentrating and poor school performance.Youngsters with these symptoms shouldhave a diagnostic evaluation with a mentalhealth professional for possible interventionand treatment. The two treatments that showthe most promise include antidepressant medicationand specialized psychotherapies. Theyinclude cognitive behavioral and interpersonaltherapy. (For further information about mentalillness and its treatment in children and adolescentssee www.AboutOurKids.org.)The National Institute of Mental Health iscurrently sponsoring a treatment study ofteenagers age 12-17 who are suffering fromdepression. The NYU Child Study Center isone of the sites in NY. For further informationcall 212-263-8613.For some teens and young adults outpatienttreatment may not be sufficient or the danger ofsuicidal behavior may be great. For them hospitalizationmay be necessary. The Young AdultProgram at the New York University ChildStudy Center was established several years agoto help older teens and young adults whosepsychiatric condition requires hospitalization.It is an intensive psychiatric inpatient program,which serves the mental health needs of theoften-neglected population of 15 to 24 yearolds.Experts from NYU in the fields of psychiatry,psychology, social work and nursing,draw on leading-edge therapeutic techniquesand breakthrough pharmacological research intreating patients. Emphasizing rapid assessmentand individualized attention, this team ofexperts strives to restore balance to a young lifein turmoil and help the young adult return toactive life. For further information about theprogram call Dr. Naomi Weinshenker at 212-263-5956.#Glenn S. Hirsch, M.D. is the DeputyDirector of the NYU Child Study Center andAssistant Professor of Psychiatry.drugs. The true innovative genius ofspheramine, which was pioneered by the brilliantneurologist Dr. Ray Watts of EmoryMedical School, is that the replacement cellsinjected into a patient don’t eventually witherand die. They maintain their potency for anextremely long time. What’s more, as many as10,000 patients could be treated by a singlebatch of retinal cells!My personal neurologist, the aptly-named Dr.Donna Masterman of UCLA, firmly believes Iam making the right choice in pursuingspheramine therapy versus DBS or another formof treatment. Dr. Masterman is expertly familiarwith the tribulations of Parkinson’s and feels thatreplacement cell technology is right for my bodyand stage of the disease. Replacement cell technologybears such unique promise that MichaelJ. Fox’s foundation has donated over four milliondollars to its furtherance.During my intensive research in the lastfew years, I learned that spheramine is the firstproduct of a company called TitanPharmaceuticals. Though spheramine has yet tocomplete the necessary clinical trials to attainFDA approval, it has completed phases I and IIof safety and efficacy and all six patients inthe clinical trial of spheramine have demonstratedmarked improvement. In an April 18,2002 news release, Alison Roselli, Titan’s directorof corporate communications, reported onthe six individuals in the pilot study, “Patientsexperienced an average of 48 percent improvementin motor “Universal Parkinson’s DiseaseResearch Score” (UPDRS) over all otherParkinson’s medications. [They also experienced]an average of 43 percent improvement incontinued on page 30