Your Best Life - 2023

YOUR BEST LIFE and THE FIGHT AGAINST CANCER

Few diagnoses are as unwanted and frightening as cancer. Yet today, great strides have been made in treating and preventing the illness.

This October, in tandem with Breast Cancer Awareness Month, Your Best Life will publish its next installment: a comprehensive guide to the latest, most encouraging news about the fight against cancer, focused on resources right here in Louisiana.

We’ll interview top local physicians about promising new treatments, while working to understand the latest research into prevention.

Readers will learn about cancer treatment clinics here in our area where experts are crafting new ways to prevent, diagnose and treat the illness.

There’s more hope than ever in the fight against cancer. Read all about it in Your Best Life in October.

Coping with life's circumstances can require professional aid. We are here to help.

When the Buffalo Bills’ Damar Hamlin collapsed on the football field after going into cardiac arrest, it became apparent that many of his teammates on the field that night were having bouts of anxiety just waiting and watching as the tragedy unfolded.

Within a short time, the NFL realized that the mental health of all of the players needed to be addressed. That in turn called attention to the fact that at times, everyone may need professional help to cope with life’s circumstances.

“There has always been a stigma attached to mental health and it’s something we’re working hard to change,” said Gyl Switzer, executive director of the National Alliance on Mental Illness.

“A lot of the people who work for NAMI have serious mental

illnesses, and that’s why we like to stress that treatment works."

In fact, nearly one in five American adults will have a diagnosable mental health condition in any given year, according to the national education and advocacy nonprofit Mental Health America.

Under the mental health umbrella, anxiety disorders are most prevalent. Mental health professionals agree that the fear and isolation brought on by the recent pandemic have only exacerbated this particular problem.

But mental health issues are very expansive to treat, and include everything from bipolar disorder and clinical depression to attention deficit hyperactivity disorder, along with autism spectrum disorders. Included also are post-traumatic stress disorder, schizophrenia

with psychosis, as well as eating disorders, and beyond.

All of the disorders are described in the bible of psychiatry and psychology, the Diagnostic and Statistical Manual of Mental Disorders.

As a society we throw words like “depressed” around fairly frequently, but being depressed about something specific and shortlived is not analogous to being clinically depressed. Likewise, it's important to differentiate between those who experience anxiety about something in particular and those with a lingering diagnosed problem.

It is those distinctions which this supplement will address, along with describing in detail some of the most common mental health disorders — and most importantly, where to get help.

The most important thing to remember is that mental health disorders are no different than any other ailments we face, whether it’s heart disease, diabetes or cancer.

These are brain disorders that

can be treated. Those diagnosed and treated earlier, fare much better.

“If someone rings NAMI’s doorbell in crisis, we will deescalate the situation,” explained Gladys Campbell, LCSW, Director of Education for NAMI. “We’ll then get them to the proper people for help.”

It is in that spirit that we move forward in detailing mental health disorders, in the hope that if the signs and symptoms sound familiar, and you or someone you care about needs help, the resources and tools will be provided to direct you to vitally needed treatment.

Leslie Cardé

Leslie Cardé is an award-winning New Orleansbased journalist. She covers topics ranging from medicine to entertainment while working as a special projects medical producer for CBS. Visit her website at lesliecarde.com.

Reporting by Leslie Cardé and Amanda McElfresh

Layout and design by Emily Sucherman • Edited by Annette Sisco

Cover by Brian Golden

Alisha Owens is vice president of sales for Georges Media.

For eating disorders, 'food is the medicine' as Children's Hospital launches feeding clinic

By Leslie Cardé | Contributing Writer

When pop music sensation Karen Carpenter succumbed to anorexia in 1983, she was only 32 years old. She had struggled with an unpublicized eating disorder since she was in high school and died of heart failure after her body, in a constant state of starvation, failed from the physiological stresses put on her organs for a decade and a half.

At 5’4” tall, she weighed 90 pounds when she died and still thought she looked “heavy” in some of her publicity photos. Her death brought awareness to eating disorders and is not dissimilar to the stories of many children and adolescents today in our weight-obsessed culture.

Eating disorders have the highest rate of mortality of all psychiatric diseases. When the pandemic began in March 2020, Children’s Hospital began to notice a big uptick in cases of severe eating disorders in their emergency room.

However, no in-patient facility in Louisiana would admit children or adolescents specifically to treat an eating disorder. Those families went to Houston or Atlanta or Miami until they were stable enough to be released and treated at an outpatient facility closer to home.

Amy Henke, who has a doctorate in psychology and was on staff at Children’s Hospital of New Orleans, wanted those with eating disorders to remain in their homes and still receive bonafide treatments that had a proven record of success.

The result was the first hospitallocated feeding and eating disorder treatment program in Louisiana. It opened in November 2022.

“We use family-based therapy out of Stanford University,” said Henke,

PsyD, a pediatric psychologist at the CHNOLA Feeding and Eating Disorders Clinic.

“The first pillar is weight restoration. We used to think we had to get patients to overcome their psychological issues first and then get them to eat. We now know differently.

“This treatment was developed specifically for adolescents and children. We know that these kids don’t want to eat. So, we get their parents and families involved. Parents must insist that kids eat... so that they serve as an in-patient facility of sorts, like a nurse would at a brick and mortar in-patient facility. Only in this case, the child is monitored from home.”

Enforcing 'consequences'

The clinic at Children’s Hospital includes a dining area, where the patient and the family work together with the psychologist and dietitian to encourage healthy eating. The family is often asked to bring a meal that they think will encourage their child to eat.

“We step in and ask the parents how they might get their child to eat in this moment,” Henke said.

"Then, we start brainstorming. I sometimes ask, what would they do if their child had cancer and didn’t want chemotherapy. What about if they had a broken leg and insisted on running?

"What it comes down to is choosing between life and an eating disorder. If the child chooses the eating disorder, then they’re too medically compromised to have a

phone, to go to that dance, to go to their school.

"It’s not about punishing, it’s about making kids understand that there are choices in life, and sometimes there are consequences for the bad choices they make.”

Common eating disorders include anorexia nervosa, where people avoid foods or severely restrict their intake. They are often in denial about the seriousness of their low body weight.

They may have to contend with thinning bones, muscle deterioration, brittle hair and nails, severe constipation and the possibility of multi-organ failure.

Bulimia is a condition where people eat unusually large amounts of food (called binge-eating), followed by forced vomiting, excessive use of diuretics or laxatives, fasting, excessive exercise, or a combination of these behaviors. Purging can have drastic health repercussions.

Eating disorders run in families, and researchers are working to identify DNA variations linked to increased risks. The newest studies have found differences in patterns of brain activity in women with eating disorders compared with healthy women.

While the disorder has traditionally affected women, it’s on the rise in boys and men, thanks in part to social media, where chiseled images on Instagram lure boys with unrealistic expectations.

Social media has had a major effect when it comes to eating disorders, when sadly so much of what’s seen on the internet has been manipulated and edited, while young kids are literally dying to meet these ideals.

WHICH COMES FIRST?

People with eating disorders often have other mental disorders, like anxiety, depression, and even obsessive-compulsive disorder. But which problem incites the other?

“That’s a chicken and egg question,” Henke said. “Is it anxiety initially, then the eating disorder, or the other way around? I can tell you that starvation creates mental health problems. But, anxiety can lead to OCD and eating disorders. So, it’s hard to know which precedes the other.

"There are typical personality styles that are seen with eating disorders. Perfectionists, high achievers, extremely goal-oriented folks, and those in high-pressure settings.”

Once the patient is eating, behavioral therapy can be employed, and in some cases, medications, if indeed there are other co-occurring illnesses, but Henke says there’s no magic bullet.

“It’s an incredibly challenging problem,” Henke said. “Family-based therapy can last anywhere from six to 18 months... But, when anorexia goes on after childhood into adulthood, there is a 1 in 8 death rate, so whatever struggles there are, it’s worth it for the sake of recovery.

"There is no medicine created for eating disorders. Food is the medicine.”

Although most referrals come from pediatricians, if your child has a known eating disorder, you can call the eating disorders clinic directly for an appointment at (504) 896 9827, or email them at cheatingdisordersclinic@LCMChealth. org.

--- Leslie Cardé

Bipolar disorder: Family history, triggering situations combine to worsen symptoms

By Leslie Cardé | Contributing Writer

In the extreme, this disorder formerly known as manicdepression, encompasses moods which can range from extremely energized behavior to sad and hopeless periods.

“People are much more aware of mental health these days, but they don’t always understand it,” said Michael Dicharry, M.D., assistant professor of clinical psychiatry for LSU.

“The word bipolar is thrown around a lot, particularly with kids in college, who may be going through finals. But, lack of sleep and trouble concentrating may lead to yo-yo moods ... this is to be expected considering the stress.”

True bipolar disorder, which involves a chemical imbalance in the brain, is typically diagnosed during adolescence or early adulthood.

During mania, people may experience delusions of grandeur, may jump from topic to topic while speaking, and often can’t stop talking in an uninterrupted stream of consciousness, which, says Dicharry, makes others very uncomfortable. Severe manic symptoms may require hospitalization.

Depressive episodes can include feeling restless, sleeping too much, trouble concentrating and a lack of interest in almost all activities. Extreme episodes can involve feelings of worthlessness and even thoughts of suicide. Extreme moods on either end of the manic-depressive spectrum can result in psychosis.

Healthcare providers base diagnoses on symptoms and family history, not brain imaging, although newer research has indicated that the brains of those with bipolar disorder may exhibit differences from those without the disorder. There’s a genetic component as well, but genes don’t tell the whole story.

“In identical twins, the incidence is only 50%, which means it’s not entirely genetic, and may also come from other genes, as well,” Dicharry said.

“It can be environmental, as well. A study which looked at Syrian refugees who had fled to Scandinavia after relentless bombings in Aleppo indicated increased rates of psychosis because of exposure to constant trauma. So stress can induce a variety of mental disorders, even psychosis.”

Anti-manic meds

Most treatments for bipolar disorder involve classes of drugs known as anti-manic agents, anticonvulsants and atypical antipsychotics, which change the activity in the brain and stabilize mood.

All of these medications may have unpleasant side effects for some patients. In particular, some people object to the way these drugs flatten out their personalities, removing the very highs and lows.

However, psychiatrists agree that it's important to weigh those effects against dangerous behavior caused by the disorder.

“Manic episodes can ruin your life,” Dicharry said. “A financial analyst with bipolar disorder gave away his entire 401K to the homeless, then traveled across the country to marry Taylor Swift. This sort of behavior just isn’t sustainable.”

Bipolar disorder is a lifelong illness, so it’s important that patients learn to manage their symptoms. Psychotherapy is important, and along with cognitive behavioral therapy, this includes the newer IPRST therapy, an acronym for interpersonal and social rhythm therapy. It aims to minimize disruptions to daily routines and rhythms since these changes can lead to disrupted sleep and an unstable mood in some people.

Another treatment option for those who have not improved with therapy or medication is ECT, or electroconvulsive therapy, a brain stimulation therapy that

BIPOLAR DISORDER AND SUBSTANCE ABUSE

Mental health disorders and substance abuse can go hand in hand.

“Mental health disorders and substance abuse can co-exist because of common genetic factors or common susceptibilities,” said Ben Springgate, MD, PhD, Professor and Chief of Community Population Medicine at LSU Health.

“Dual disorders are not uncommon. Basically, someone with a mental health disorder is looking for a way to feel better when they are in a state of disarray from their illness.

"All medications have side effects beyond their intended use. This can change how the neurotransmitters work in the brain, and may make those with bipolar disorder feel uncomfortable with themselves when using their prescriptions.

"Perhaps it’s hard to sleep, or recall a name. They often look for alternatives.”

Springgate says those with bipolar disorder should be screened for substance abuse, as self-medicating with alcohol and illegal drugs is one of the coping mechanisms.

can help relieve severe symptoms of bipolar disorder. A seizure is induced while the patient is asleep.

"Most patients see improvements after two or three sessions, and after 12 sessions are cured," Dicharry said. "There are some who need maintenance sessions ... actor Carrie Fisher, who has spoken about this in her books, had ECT from the 1980’s

Stressful, triggering situations should be avoided. Individual or group therapy can help prevent addiction, especially support groups with others who have similar diagnoses.

As with other mental illnesses, people with bipolar disorder may also suffer from other disorders like anxiety or depression, increasing tendencies to self-medicate. “It’s important to remember these are health problems, not moral failings,” Springgate said. “But, using street drugs now comes with a special danger in that many are laced with Fentanyl, which can be deadly.

"This is why it’s so important to find the right medication for all mental health disorders, that come with the fewest side effects, and are tolerated by the patients using them.”

To find local treatment services in your area, call the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Referral Helpline at 1-800-662-HELP (4357).

--- Leslie Cardé

into her older age.”

One of the biggest problems with treating bipolar disorder is non-compliance on the part of patients with their prescribed medications. Some patients who come off of their prescribed meds use alcohol or other drugs to self-medicate. But that can lead to addiction, because these patients, genetically, are more susceptible.

Dr. Michael Dicharry

How UMC helps trauma patients recover physically and mentally after life-changing events

psychological effects immediately after the event or later?

It depends. It’s situation-specific and individualized because how someone responds to an event is informed by a lot of variables. You might think about what others in your family have been through, which affects how you navigate your own situation. Other factors include the severity of the physical injuries, stress about insurance or finances, safety concerns, and whether someone else was injured or died in the event.

It's possible to not have any signs of psychological trauma or PTSD in the early days and then things pop up later. Part of trauma response is compartmentalizing and avoidance. People might push their thoughts to the side and carry on, but may be triggered later by something that reminds them of the traumatic event.

What is it like to work for a hospital and healthcare system that places such a high value on psychological care?

Medical Center New Orleans after a trau matic event, it can be the beginning of emotional challenges as they cope with their recovery. Whether the person has been in a vehicle crash, a work accident, a violent incident or another situation, the UMC team ensures they receive holistic care. Dr. Erika Rajo, a trauma psychologist, leads a team of mental health professionals who work alongside clinicians to make sure each patient’s physical and emotional needs are met. Here, Dr. Rajo describes

ual who comes for a medical visit. The people that I see are not coming to see a psychologist. They are here for another medical reason. After they arrive, my team reaches out to see if they need mental and emotional services. Sometimes, they want to talk right away. Other times, we leave them the information on our resources, like our outpatient clinic and support groups. We provide several options but also meet the person where they’re at in that moment. We don’t push anything they’re not ready for.

How can someone’s mental health affect their physical recovery after a trauma?

If someone isn’t going to physical therapy because they’re afraid to leave

just two examples. We also consult with the patient’s primary treatment teams to help them understand that the person is not refusing care just because they don’t want to. There are usually psychological reasons.

What kind of responses do trauma patients have when you reach out?

People are more receptive than not. I’m always quick to let them know that our visits are routine and part of their overall care. I think the great part about our process is that people who may not otherwise walk into a mental health clinic or recognize signs of psychological trauma get that information right away after something happens.

Do trauma patients experience

ING YO UW ELL to try new things things

It’s amazing because psychology in a medical setting has not always been well-received, even at other hospitals where I’ve worked. Our team is really valued and I think people are continually recognizing the importance of the psychological aspects of trauma. We are consulted on every trauma patient automatically, but sometimes doctors will reach out to us about a non-trauma patient because they’re seeing signs of emotional distress. That means people here recognize the importance of addressing both the physical and mental aspects of care. We’ve also done a number of initiatives to provide support to our own health care workers and providers, because they can experience secondary trauma from providing treatment. We are here to support everyone.

Dr. Erika Rajo

Anxiety disorder normal worrying? There are ways to tell the difference.

By Leslie Cardé | Contributing Writer

If you worry about finances, your health, or family matters, that’s a normal part of life. But if your anxiety is more generalized, never goes away and is getting worse, it’s time to take stock.

“Clinical anxiety is more excessive and more persistent” than normal worry, explained Nathan Brown, PsyD, LSU Clinical Psychologist at UMC. “It can last for six months or more and begins interfering with your social life, your personal and work life, and even with your ability to experience pleasure. It can also have a negative impact on your productivity.”

The symptoms of clinical anxiety disorders are far-reaching. They include feeling restless or on edge, which can lead to being easily fatigued.

It can become difficult to concentrate, and it’s easy to become irritable. Symptoms can include headaches, muscle aches, stomachaches, unexplained pains, and sleep problems.

So, why do some people suffer general anxiety disorders, while others don’t?

part psychological, and even has cultural causes,” Brown said.

are inherited, so we have the genetic component. But, if you’re being raised by someone with an anxiety disorder, you might also model your behavior after that person. And, since neuroticism is a personality type, where people are anxious about having future anxiety, stressful experiences in the past may lead to a present fear and anxiety.”

Anxiety disorders come in all shapes and sizes, and can be very specific to one particular fear.

Phobias produce fears of everything from heights (acrophobia) to spiders (arachnophobia), and the allencompassing agoraphobia which brings on fear of places and situations that may cause panic, helplessness, or embarrassment.

Many people with this disorder are afraid to leave their homes, so the anxiety produced can be paralyzing, especially when something as basic as standing in a line or being in a crowd can incite terror.

Separation anxiety disorder is often thought of as something that affects children and pets, but adults are equally vulnerable. In its severe

disorders result in unrealistic fears about being negatively evaluated by others. This worry causes many with the disorder to avoid social settings altogether.

Panic disorders produce panic attacks that are sudden and intense. There’s a sense of losing control even when there’s no imminent danger.

A person may experience a pounding or racing heart, trembling, sweating, nausea, rapid breathing, or chest pain. Panic attacks can occur as frequently as daily or as rarely as several times a year, but the fear of the next attack can itself provoke anxiety.

Although the risk factors for each type of disorder may vary, researchers have found that some general risk factors include shyness or nervousness with new situations during childhood, exposure to stressful life events, or a history of mental disorders in biological relatives.

If you think you have an anxiety disorder, a health care provider can make a diagnosis and ultimately help you find the proper treatment.

TREATMENT

Anxiety disorders are treated with psychotherapy, medication or both. Cognitive behavioral therapy, or CBT, is considered the gold standard.

“People’s thoughts affect their mood and behavior, so if we can teach people to think more positively about situations then the task at hand doesn’t seem so overwhelming,” Brown said.

“So, with CBT, we target negative and dysfunctional thinking in order to conquer problems.”

A newer therapy known as ACT, or acceptance and commitment therapy, takes a different approach, stressing mindfulness and goal-setting to reduce anxiety. It’s about living in the moment and making a commitment to changing behavior.

While proponents of talk therapy say it’s helpful to develop a different perspective on your thoughts, there’s no denying that some people, depending upon the severity of their situation, may need medication to get them through the rough patches.

Most drugs used to treat anxiety are anxiolytics like Valium or Xanax, just to name a couple of familiar ones.

These sorts of drugs, known as benzodiazepines, work like mild sedatives and can be habit-forming. Therefore, they are recommended only for short-term use. Antidepressants are also used to treat anxiety. They come in different classifications, including SSRIs and SNRIs, and have brand names like Prozac and Paxil, or Cymbalta –but the antidepressant list is a long one.

These medications work on brain chemistry and can cause withdrawal when stopped abruptly, but can be very useful in alleviating the devastating symptoms of anxiety. Deciding what medicine to take, or if meds are needed, should be in conjunction with a specialty healthcare provider. Psychiatrists say it may take several tries to find the right medication for each person.

For more information, the Anxiety and Depression Association of America has a helpful website, adaa.org.

Since severe anxiety can produce suicidal thoughts, if you feel you’re in danger of selfharm, call the National Suicide Prevention Hotline, 24/7, 365 days a year. Simply dial 9-8-8

University Medical Center in New Orleans has a Behavioral Health Clinic where calls are screened to determine what an individual may need. Interpreters are provided free of charge. (504) 962-7020.

--- Leslie Cardé

Children’s Hospital New Orleans provides care and resources to help patients like Sophia cope with mental health challenges

By Amanda McElfresh amcelfresh@theadvocate.com

This story is brought to you by Children’s Hospital New Orleans.

Sophia Juhaz wouldn’t be alive today without the care she received from Children’s Hospital New Orleans’ Behavioral Health Center.

Juhaz, now 18, was admitted to the center twice in 2021 after attempting suicide. She had long struggled with anxiety and depression, which took a growing toll. But, she wanted to get help and voluntarily checked into the center both times, with her family’s full support.

The 51-bed Behavioral Health Center at Children’s Hospital is the only psychiatric program in the Gulf Coast region that is exclusively dedicated to the mental healthcare needs of children and adolescents in crisis, and is one of the largest and most comprehensive pediatric programs in the country. Inpatient and outpatient services are available for treatment of a wide range of psychiatric and behavioral disorders.

Data shows this care is needed now more than ever. Recent Centers for Disease Control and Prevention statistics show that in 2021, 57% of teenage girls reported persistent sadness or hopelessness and 30% said they have seriously considered suicide. There have also been increases in the past decade among teenage boys who report those same feelings. Experts noted that teens’ mental health struggles appeared to increase around

2012 and have not slowed since.

Juhaz said that during her treatment, she and other patients took part in regular meals, daily check-ins to establish and review progress on goals, conversations with social workers, and various therapies and treatments. Art and music therapy helped them process emotions.

The program also ensured she would receive care after she was discharged. During therapy, the staff explained how patients can connect their emotions to real-life experiences and handle them in safe and appropriate ways. Juhaz had arranged to continue treatment with a therapist and a psychiatrist after she was discharged, but the Behavioral Health Center makes those connections if needed.

Elizabeth Kemmerly, a licensed clinical social worker and outpatient therapist at the Behavioral Health Center, said a key part of treatment is helping patients

learn skills based around coping, calming and communication. These can include mindfulness, breathing exercises, reframing thought, identifying emotions and explaining them to others.

“We want people to know they are not alone, that other people go through struggles, and that mental health is health,” Kemmerly said. “Our treatment includes family sessions led by a therapist to learn more about what brought the child to the center and teach the family the appropriate skills and techniques to help that child.”

Kemmerly said potential warning signs of a mental health problem may include changes in a person’s baseline behavior, such as isolation, sleep or appetite changes, or urges to harm oneself or others. She is especially proud of Children’s Hospital New Orleans’ community outreach work so clinicians can address problems sooner.

“We’re passionate about being in schools

and other places where children might need access to people to talk through their thoughts and get help processing them,” she said. “We are working to destigmatize these problems so people, including our youth, don’t feel shame in talking about mental health.”

Today, Juhaz is doing well and continuing outpatient care. She has launched a teen wellness council program in Jefferson Parish Public Schools for students to discuss overall mental health on their campuses and ways to address concerns. She also has worked with local school leaders to increase the number of social workers on area campuses.

“I’m beyond grateful for everything that Children’s Hospital has done for me and other patients,” she said. “There’s still a stigma in society around mental health and it’s so important to normalize the fact that depression and anxiety is real. If anybody is reading this and looking for a sign to stay alive, this is your sign. It does get better.”

The Behavioral Health Center staff is well-trained on treating children and adolescents with a variety of conditions, including ADHD, autism, mood disturbances, trauma and grief and more. Services include psychiatric consultations, neuropsychology, virtual care, emergency services and more. The center also oversees numerous school-based programs and a partnership with the juvenile justice intervention center. For more information or to schedule an appointment, visit chnola.org

Treatment for chronic depression has improved as doctors better understand the illness

By Leslie Cardé | Contributing Writer

Clinical depression isn't the same as depression caused by a loss such as the death of a loved one, a divorce, or finding out you have a serious medical condition.

Also known as major depressive disorder, it's pervasive and all-encompassing. It causes symptoms that affect how you feel, think and handle regular activities such as eating, sleeping or working.

“It’s characterized by slow moves, loss of pleasure, low energy, change in appetite, concentration problems, pathological guilt, psychomotor slowing, inappropriate guilt and suicidal thoughts,” said Lochlann McGee, M.D., assistant professor of psychiatry at LSU Health.

“In order to be diagnosed with this disorder, a patient must have five or more of these symptoms for two weeks or more, and (it must) account for the majority of the person’s day.”

There are different types of depression. Persistent depressive disorder (also called dysthymia) often includes less severe symptoms, but they can last much longer, typically for at least two years.

Perinatal and postpartum depression occurs when a woman experiences major depression during pregnancy or after delivery. McGee, who staffs the high-risk OB clinic at UMC, says that when depressive symptoms last for at least six months, the woman should be diagnosed and treated.

“We should note that this is a depression based on a special circumstance," McGee said. "Rather than having a genetic component, hormonal fluxes can cause this sort of depression."

Though it's called depression and has the same symptoms, it’s a separate condition, McGee said. The medication that doctors prescribe for pregnancy-related depression doesn't help with other kinds of depression.

Risk factors

Risk factors for depression include a family history, major life changes that involve trauma or stress, or certain physical illnesses and medications.

Sometimes, medications taken for particular illnesses such as diabetes, cancer, heart disease and Parkinson’s may cause side effects that

LIFT THE MOOD

Beyond medical therapies, including talk therapy, there are things people with depression can do to lift their mood.

Thirty minutes a day of simple walking boosts mood.

Maintaining regular routines helps with mood... maintain a regular bedtime and wake-up time.

Prioritize tasks, and do what you can, but let the less important things wait.

Try to connect with other people. A study out of Ohio University, released in January, showed that helping others promoted healing, and often gave those who felt hopeless a sense of purpose.

Hold off on important decisions like marriage, divorce, or job changes, until you feel better.

Address substance abuse. “Lots of insomnia and substance use is a bad

contribute to depression, so it’s important that physicians work out the best treatment strategies.

Patients may need to try several antidepressant medications before landing on the one that relieves symptom with a minimum of side effects. These medications can take from four to eight weeks to take effect, and often symptoms such as sleep, appetite and concentration problems improve before one’s mood lifts, so patients must give medications time to fully take effect.

“I will tell you that SSRIs, the classification of drugs used for these patients, are not happy pills,” said McGee.

“My patients sometimes tell me that it gives them a thicker skin, so that the things that bothered them previously and interfered with their lives don’t stick with them any longer. That’s the ideal situation, but it may take some adjustment.

"Too high a dose, and patients say they feel blunted: They aren’t happy, they aren’t sad, they just are. No one likes this feeling.”

For those with major depressive disorders that aren't responding to medication, McGee says brain stimulation therapies work best. He also is a proponent of electroconvulsive therapy and believes that hands down, it works best for severe depression --- double the rate of remission as drug therapy.

Other brain stimulation therapies include transcranial magnetic stimulation and vagus nerve stimulation. Other forms of this treatment are currently being studied, because for those with suicidal thoughts, it’s critical to reverse the course of the disease.

combination.... impaired decision-making is a result,” McGee said. “Reach out to others and avoid isolation. Many connections were severed during the pandemic, and it’s important to get them back. Depressed people often don’t share their burdens, and don’t ask for help, often because they don’t think they deserve it.”

McGee emphasizes that those with depression are not weak; they have a brain disorder. MRIs now show that parts of the brain that are illuminated in most people are "dark" in those who have chronic depression.

If you know someone who has suicidal thoughts, it’s important to provide help. The Suicide and Crisis Hotline at 9-8-8 provides trained crisis counselors who anonymously aid those in immediate need.

For more information about depression, go to the Depression and Bipolar Support Alliance at dbsallliance.org

--- Leslie Cardé

RKM has multiple treatment options and resources for patients from all walks of life

Primary Care.

With individualized approaches that can include both therapy and medication, RKM Primary Care is helping people overcome mental health problems and return to their daily activities.

When someone first reaches out to RKM Primary Care, a social worker completes a biopsychosocial assessment. This includes background information about the person’s mental health, substance use and family history, as well as support systems. From there, the social

assessment if it is determined that the person would benefit from medication. In some cases, a patient may only need medication, while others may need therapy. RKM Primary Care offers individual, family and group therapy.

“All of the studies tell us that the best outcomes come from a combination of medication and therapy,” said Gary Chaney, DNP, APRN, PMHNP-BC and RKM’s director of behavioral health services. “Some people may have mild depression or anxiety, so they see a therapist and learn coping skills and never

social workers do make recommendations that they believe will benefit the person the most.”

Chaney said the length of treatment varies and depends on each person’s individual circumstances.

“If a patient is dealing with an acute situation, like the death of a loved one, those treatments tend to be shorter,” he said. “But oftentimes, especially with therapy, it’s a commitment that can last several months depending on how deep-seated the person’s issues are.”

Chaney said other factors can also

contribute to the length of someone’s treatment, including their exact diagnosis and how much effort someone puts into their treatment, such as keeping scheduled appointments, taking medication as prescribed and completing assignments as outlined by their therapist. With some newer medications, patients may see relief in two to six weeks.

Chaney said RKM treats people from all backgrounds, demographics and age ranges. Some of their most common mental health challenges include depression, anxiety, post-traumatic stress disorder, bipolar disorder and schizophrenia. Some patients had longstanding conditions that have been exacerbated by the events of the last few years, including the COVID-19 pandemic and subsequent lockdowns, economic uncertainty and natural disasters. However, Chaney said other people have begun experiencing these challenges for the first time.

“Sometimes people might recognize on their own that things don’t feel right,” Chaney said. “We usually don’t see people until they realize that their daily lives are being affected. When people realize they are isolating themselves and are not able to participate in life the way they are used to, that’s usually when they realize something needs to be done. Sometimes, it might be someone else who notices these changes. A lot of times, family members, friends or co-workers can see it before the patient does. They recognize that someone is acting differently and become concerned.”

RKM Primary Care has locations in Baton Rouge, Clinton, Jackson, Livingston, Loranger, Port Allen, Slaughter and Springfield. For more information or to schedule an appointment, visit www.rkmcare.org or call 844-RKM-4YOU .

When rituals make life more difficult: Diagnosis and treatment of OCD

By Leslie Cardé | Contributing Writer

OCD is typically treated with a combination of psychotherapy and medications. Although most patients get relief from their symptoms, some patients continue to experience debilitating symptoms. Some people with this disorder also have other mental disorders alongside their OCD, among them anxiety, depression, and psychomotor tics (often seen in Tourette’s Syndrome).

For those who have been prescribed medication, it’s important to talk to health care providers about the risks and side effects. Never stop taking medications suddenly, as rebound effects can take place, possibly making symptoms worse, while the body experiences withdrawal symptoms.

Four years ago, the FDA approved a brain stimulating procedure called Transcranial Magnetic Stimulation as an adjunct in the treatment of OCD in adults.

Imagine being late to all your appointments because getting out of your house entails so many time-consuming rituals that you’re spending an hour repeatedly going back to your house to make sure the door is locked.

That’s a scenario that could occur if you have OCD, obsessive compulsive disorder.

“I should point out that ObsessiveCompulsive Personality Disorder is different from OCD,” explained Dean Hickman, M.D., Ochsner psychiatrist and system chairman of the Behavioral Health Service Line.

“The personality disorder is an obsession with orderliness, perfectionism and cleanliness, just to name a few of the obsessions and compulsions.

"But these are less intrusive than a true case of OCD, in which the obsession consists of persistent and unwanted thoughts and urges, which are intrusive.

"The compulsion portion involves

repetitive behaviors that act on those urges."

For the diagnosis to apply, "the rituals have to be excessive and take up more than an hour a day. If you circle the block six times because you think you may have hit a squirrel, this is an example of OCD.”

Those who cannot throw things out, known as hoarders, fall into the OCD category as well.

Even when the hoarded objects take over an entire house, those with the disorder cannot stop collecting superfluous items. They may know their behavior makes no sense, but they can’t help themselves.

Shower after shower

Comedian Howie Mandel has talked extensively about his OCD, which he says wasn’t diagnosed until he was an adult, though he displayed all of the symptoms in his childhood.

Obsessed with germs, he would take shower after shower. He would find himself lining up the fringe on his friends' rugs.

“Psychiatrists have had some of the best results with Exposure and Response Prevention therapy,” said Kathleen Crapanzano, M.D., associate professor of clinical

psychiatry at LSU Baton Rouge.

“With germaphobia, for example, we might gradually make the patient’s hands dirty, and try to get them to tolerate not washing their hands. It’s a form of cognitive behavioral therapy that involves confronting the thoughts, images and situations that make you anxious and/ or provoke your obsessions in a safe environment, in the hope that you learn to deal with these obsessions in a healthy way.”

Although there is no specific gene for OCD, research has shown that the disorder does run in families. Those with a parent or sibling who has OCD are at higher risk. There are other suspected causes, which include childhood traumas. In some cases, children may develop OCD or its symptoms following a streptococcal infection (strep throat, for example). These are known as PANDAS, for Pediatric Autoimmune Neuropsychiatric Disorders Associated with

“It’s a machine that uses a magnetic impulse which is safer and with less side effects than ECT (electro convulsive therapy),” said Hickman. “It’s been used already for severe depression ... It involves sitting in a glorified dental chair while an electromagnetic coil is placed on the scalp near your forehead. The magnetic pulse stimulates nerve cells in the region of your brain involved in mood control."

For those suffering with OCD, life can become an isolating series of smaller and smaller concentric circles, because patients tend to avoid situations that cause stress.

If they can’t get to a meeting on time, for example, they eventually avoid meetings altogether.

If you or someone you know think you may have symptoms that may be part of an OCD disorder, there is a quick online test, called the Yale-Brown OCD Scale. It is used for screening, with the caveat that no single test is meant to be a diagnosis and all results should be discussed with your healthcare provider. Go to: www.addictionsandrecovery.org/ tools/obsessive-compulsive-disordertest-yale-brown-ocd-scale-ybocs.pdf

--- Leslie Cardé

Streptococcal infections. Imaging studies have shown changes in the brain structure of those with OCD. There seems to be a connection between symptoms and abnormalities in certain areas of the brain. However, that research is underway. Understanding the causes of this disorder will ultimately help with the treatment.

Regions Behavioral Hospital

awareness about mental health conditions has led to more people acknowledging their own challenges. That has resulted in an uptick in patients struggling with post-traumatic stress disorder, as well as anxiety and depression.

Many Regions patients approach the center on their own, while some arrive after going to a local emergency room if they experience suicidal thoughts or another type of mental health crisis.

“I’ve heard many times from people who have gone to treatment centers and say their experience was traumatic. We never want people to feel that way about coming here,” Dr. Khan said. “Our focus is on getting people compassionate and appropriate care at an appropriate level.”

The care at Regions is provided by a team of about 100 people whose commitment is focused on getting people the right treatment. During COVID, the staff began triaging patients upon entry to determine the best care, a practice that continues today. Although Regions wants to help as many people as it can, Dr. Khan said it is also open to referring people to other resources if the staff feels it may be a better fit.

When Stephen Richardson founded Regions Behavioral Hospital, his primary goal was to ensure that patients felt safe, respected and loved while receiving the best possible mental health treatment. Although Richardson passed away from cancer in 2022, the hospital staff is continuing his legacy with those same core values at the forefront of their work.

“I think what really sets us apart is that our team lives that motto when it comes to treating patients and giving them that experience,” said Regions CEO Marc

Regions has both inpatient and outpatient services available. Inpatient treatment is designed for people who are in immediate crisis and need substantial care to become stable. Outpatient services include an Intensive Outpatient Program for both mental health as well as substance abuse, psychotherapy, holistic therapies, and medication management. The Regions team is experienced in treating a wide range of conditions, including depression, anxiety, post-traumatic stress disorder, bipolar disorder, schizophrenia, suicidal

ioral Hospital. In the years since, some recent trends have emerged. For example, Dr. Abdul Majid Khan, Regions’ medical director, said many more people across all demographics, including those in higher socioeconomic tiers, are struggling with substance use disorder, particularly with opiates and methamphetamines. Because of that, Dr. Khan said Regions has added medication-assisted treatment as a component of its substance use disorder care.

In addition, Dr. Khan said an increased

“Our philosophy really resonates with our staff,” Crawford said. “We’ve never used a staffing agency and we have very little turnover, which I think speaks to how Stephen set up the company and culture. We attract nurses who have not traditionally worked in mental health but realize the importance of it and want to be a part of what we are doing. It really is a great team.”

Regions Behavioral Hospital is located at 8416 Cumberland Place in Baton Rouge. For more information, visit www. regionsbh.com or call 225-408-6060.

Core values of safety, respect and love guide treatment at

When soldiers came home from World War I and experienced flashbacks and nightmares, it was called shell shock. Years later, Vietnam vets were often told to repress memories rather than deal with them.

Since the 1980s, Post Traumatic Stress Disorder has been an official diagnosis for a disorder that develops in some people who have experienced a shocking, scary or dangerous event.

Almost everyone experiences a range of reactions to trauma, though most people recover naturally. But those with PTSD continue to experience problems, and often feel stressed or frightened even when they are no longer in any danger.

According to the National Institute of Mental Health, to be diagnosed with PTSD an adult must have all of the following symptoms for at least one month:

• At least one re-experiencing symptom, which includes flashbacks with physical symptoms, bad dreams or frightening thoughts.

• At least one avoidance symptom, which includes staying away from anything that is a reminder of the traumatic experience, and avoiding thoughts or feeling related to the traumatic event.

• At least two arousal and reactivity symptoms, which includes being easily startled, having difficulty sleeping, feeling “on edge” or having angry outbursts.

• At least two cognition and mood symptoms, which includes trouble remembering key features of the traumatic event, negative thoughts about oneself or the world, distorted feelings like guilt or blame, or loss of interest in formerly enjoyable activities.

Shell shocked: Now it's called PTSD, and researchers are working to help people cope

By Leslie Cardé | Contributing Writer

“There is a genetic component to this disorder,” said Jacklyn Ruhl, PhD, an Ochsner psychologist. “In fact, the National Institutes of Health has said genetic risk factors account for 30-40% of PTSD. Trauma can be generational — passed down in your DNA to your descendants."

Anyone can develop PTSD at any stage of life. This can include children who’ve experienced sexual abuse, war veterans, victims of sexual assault and those who’ve experienced horrific accidents or natural disasters. The sudden loss of a loved one, a home or a job raises the risk of PTSD.

“We know about historical trauma,” recounted researcher Tonya Hansel, PhD, LMSW, Associate Professor, Tulane School of Social Work. “Being raised in a traumatic environment can have dramatic repercussions. We know that stress shortens telomeres, the protective caps at the end of chromosomes. If they become so short that the genes they protect are damaged, it has a harmful effect on our physiology.”

According to the National Center for PTSD, approximately seven or

eight out of every 100 people will experience PTSD at some point in their lives. Women are more likely to develop PTSD than men.

It is unclear exactly why some people develop PTSD and others don’t, but resilience factors can help reduce the risk of the disorder.

Some of the factors that promote healing after trauma include seeking out support from other people, such as friends and family, finding support groups after traumatic events and, most importantly, having a positive coping strategy.

Medication for PTSD generally involves antidepressants to alleviate symptoms of sadness, worry and feeling numb inside. Other medications may be needed to treat symptoms such as sleeplessness and nightmares.

Psychotherapy, both individually and in groups, has proven successful. A couple of cognitive behavioral therapies have been effective. Exposure therapy involves exposing the patient to the original trauma, even visiting the place where the event happened.

Cognitive restructuring helps people make sense of the bad memories, as sometimes people remember the traumatic event differently than the way it actually happened.

“It can take anywhere from eight to 16 weeks to see benefits in treatment,” Ruhl said. “Patients may have some symptoms when therapy is over, but they may no longer meet the criteria for PTSD. Success is taking away the stress impairment.”

WHAT ABOUT CHILDREN?

PTSD in children can look very different from the disorder in adults. Their responses can be mislabeled by teachers who are dealing with different behavior, not always understanding why.

“If something violent happens to a member of the child’s family, they then worry about the safety of others in the family, and their hyper-vigilance can mimic the symptoms of ADHD," said Julie Kaplow, executive director of The Trauma and Grief Center at Children’s Hospital of New Orleans.

“Many kids experience social withdrawal. Not wanting to leave their home looks a lot like depression. And sometimes, conduct problems may manifest in the classroom. Kids may be reminded of the trauma, and then lash out at another child, sometimes getting mislabeled as a problem child. Educating the teachers to what has happened to that student rather than what’s wrong with the student is critical.”

Children respond to trauma by not eating or sleeping, perhaps crawling into bed with parents.

With very young children, there might be regression in language skills or bedwetting. Irritability can result in tantrums. With older kids, there are more risk-taking behaviors, even suicidal ideations.

“There are some stark differences when trauma involves the death of a loved one,” Kaplow said. “Grief reactions involve yearning and longing, wondering how they’ll do without that person. There are often questions and concerns about how the person died: 'Can I catch cancer?' If a person close to them was shot and killed, they assume maybe they’re next.”

The Trauma and Grief Center treats children between the ages of 1 and 21. Since the center opened its doors in November 2021, the demand has been greater than anyone expected. With deaths from COVID, and the high rates of homicide, children have had a real need for counseling.

If your child has experienced trauma or grief, there is no referral necessary. The center can be reached at (504) 584-8433, Option 5 --- Leslie Cardé

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Catching schizophrenia early might save patients from a lifetime of illness

By Leslie Cardé | Contributing Writer

His name was Barry, and police found him standing on the roof of a 20-story building, ready to fling himself into the air, believing he was Superman and that he could fly. He was 22 years old, and voices in his head were telling him to jump.

When 25-year-old John Hinckley shot then-President Ronald Reagan in 1981, he was trying to impress Jodie Foster, an actress he’d never met but was obsessed with. He spent 34 years in a psychiatric facility after being found not guilty by reason of insanity.

Both men had a severe mental illness called schizophrenia, which can cause psychotic episodes consisting of hallucinations, delusions, paranoia and disordered thinking. Although most schizophrenics are not violent, they can act unpredictably at times, especially if they aren’t being treated.

“Everything about them looks normal, yet their brains are misfiring,” said Kathleen Crapanzano, M.D., associate professor of clinical psychiatry at LSU Baton Rouge. “The diagnosis of schizophrenia is a clinical one based on the symptoms. There is no blood test for this disease. For the most part, the brain is out of touch with reality. Patients can be convinced the sky is orange, and nothing you tell them will dissuade them.”

Disabling symptoms

Psychosis is not the only symptom of schizophrenia. According to Crapanzano, just as disturbing and often more disabling are symptoms such as complete apathy and an inability to experience pleasure.

Cognitive issues can also be problematic, like problems with attention, concentration and memory. Three-step commands can be hard to follow. Alongside schizophrenia, patients can also have depression.

Most schizophrenics are diagnosed in their late teens or early twenties, when they have their first psychotic break. One third of patients will spontaneously get better. One third will stay the same. One third will get worse.

There is no single gene associated with schizophrenia, but it does run in families. The risk to the general population is only 1%, but when one parent has the disease, the risk jumps to 10%. With two parents, it’s 50%. Even so, there are other factors.

“Life experiences can contribute as well," said Crapanzano, who’s treated those with schizophrenia for more than 20 years. "It’s a matrix of sorts. Was there

EARLY INTERVENTION CLINIC

There’s a movement afoot to get patients into treatment as soon as symptoms first appear. And now there’s a clinic in New Orleans that specializes in early intervention for those first experiencing psychosis.

Called EPIC, for Early Psychosis Intervention Clinic, it was co-founded by Ashley Weiss, M.D., who met a patient in the E.R. during her residency who was having his first psychotic episode. Weiss took him under her wing.

“It was post-Katrina, and this guy was in his early 20s and having delusional experiences,” remembered Weiss, who is an associate professor in psychiatry at Tulane.

“Word spread that I was seeing these patients, and I began to get referrals from hospitals and E.R.s," she said. "But I knew the key was to catch this disease in its infancy. Once you’re sick for 3-plus years, you don’t do as well. Repeated bouts of psychosis cause brain insults, which begin to affect cognitive abilities. Then, there’s everything this disease leads to in life: loss of jobs, problems with family, being shunned by society.”

Clearly, it’s better to nip it in the bud. But how? The educational arm of EPIC is CALM, (Clear Answers to Louisiana Mental health). It’s an outreach program that educates not just the public, but health professionals to the importance of treating disorders with psychosis early in the game. Considering that the average patient

child abuse or neglect early on?

In prisons, long-term solitary confinement causes psychosis.”

The disease is treatable, but it requires, in most cases, lifelong medication. And the medications have an array of side effects, ranging from Parkinsonian-like symptoms (tremors), and tardive dyskinesia (repetitive involuntary movements) to metabolic problems like high cholesterol and diabetes.

As most psychiatrists will tell you, it’s difficult to get a person who believes he’s thinking rationally to voluntarily take drugs with so many side effects. Compliance with meds is a major problem as a result.

We now know that getting proper treatment early on, and if possible after the first psychotic episode occurs, can be the first step to help patients lead the most normal life possible.

doesn’t seek treatment until they’ve had psychotic episodes for 72 weeks, it’s a tall order.

“We’ve taken out bus ads, and we’re getting people to talk about this illness, to de-stigmatize it,” Weiss said. "We had a fundraiser recently called 'In My Mind,' where patients came and talked about their hallucinations. It was eye-opening for a lot of people.”

At the moment, the task is to expand across Louisiana with a network of clinics like those in New York, California, Oregon and Ohio. The goal is to keep people out of the hospital.

“Most people with schizophrenia do not have to be institutionalized for the rest of their lives,” Weiss said.

“Yet the state facilities are full of people who never had the opportunity to get well. Many of the patients are still stuck in the story of their first episode of psychosis, when life began not to make sense anymore. We want to get past that.”

If you or someone you know may need help, you can call the EPIC clinic at (504) 988-0301, or email them at calm@tulane.edu. If you are wondering if you might need help, there is a quiz on their website at calmnola.org

--- Leslie Cardé

Helping kids with ADHD to focus, work and learn

By Leslie Cardé | Contributing Writer

The teacher calls to say that your child isn’t paying attention, is disrupting the class and just isn’t focused. You’ve noticed the child neglecting chores at home and putting off assignments.

And, when you think back, your child was a bit wild as a toddler, which you chalked up to the “terrible twos” — and beyond.

Are these behavioral issues, or could it be something else? Now, your pediatrician has suggested it could be attention-deficit hyperactivity disorder, but that diagnosis requires a professional to sort through the symptoms.

“To make a diagnosis of ADHD, there must be significant inattentiveness or hyperactivity, or impulsive behaviors,” said Susan Fielkow, M.D., a developmental behavioral pediatrician at Children’s Hospital, New Orleans.

“Some of those features can be dominant, or can be in combination with one another, but the symptoms must be greater than for their age-related peers.”

Home vs. school

The behavior must also exist in at least two different environments, as well.

So if a child is a terror in your house, but a model citizen at school, the behavior might be chalked up to something within the home environment. If your child seems like the typical child at home, getting along with siblings, but their teacher is telling you a different story, perhaps there’s a problem at school — anything from being bullied to a learning disability, which could cause frustration and acting out.

To hone in on what’s actually happening, a professional has to consider many aspects of the child’s life.

Are they on medications for allergies, which might have side effects? Are they getting enough sleep? What is the psychosocial dynamic at home and at school?

There is a long list of symptoms that fall under the ADHD umbrella. They include:

• Inability to pay attention to details

• Inability to focus

• Not paying attention when someone attempts to engage them

• Trouble with following up on instructions

• Disorganization, which turns into an inability to function

• Losing things

• Procrastinating (time management and organizational skills are causing problems)

• Easily distracted

• Squirming

• Running or climbing in inappropriate places

• Always on the go, as if driven by a motor

• Interrupting people, making it impossible to have conversations

According to experts, the inattentive component of ADHD can fly under the radar, more than the hyperactivity, which can be obvious even in a toddler. Most

children are diagnosed between the ages of 6 and 12, but it can be younger.

“Kindergarten is a breeze for some of these kids, and even first and second grade may not pose challenges for them,” Fielkow said.

“But, by the end of 3rd grade, the demand on a student starts to increase, and they can’t get by any longer without paying attention, because the work is more difficult and requires some degree of concentration," she said. "In general, higher functioning kids can mask it longer, until the curriculum catches up, and then both teachers and parents begin to see the underlying problems.”

The disorder runs in families. A mother who took her child to her physician recently for a diagnosis was surprised to learn that she had many of the same symptoms, but she had just accepted the fact that she could never read the newspaper all the way through, among other difficulties. Now that mother is being treated, and she is able to do things she never thought she was capable of.

In addition to the role genetics play, researchers are looking at environmental factors, brain injuries, nutrition and social environments.

According to Fielkow, it’s also important to remember that

For the roughly 5-12% of children who will be diagnosed with ADHD, there is no cure. The medications often given to amplify focusing capabilities are of two basic types — stimulants and non-stimulants.

Although it may seem counterintuitive to prescribe a stimulant for someone who is already hyperactive, the drugs work by increasing certain brain chemicals which play essential roles in thinking and attention.

Teaching organizational or study skills to the child has been shown to be effective in improving academic function and socialization skills with peers.

Children with a diagnosis of ADHD are also entitled to certain academic accommodations at school, such as preferential seating, reduced classwork or extended time on tests.

Schools may also accommodate through the 504 Plan, which qualifies children for special education services.

Parents and teachers can generally help kids with ADHD by keeping routines, organizing everyday items, and having consistent rules.

“Most importantly, it’s critical for parents to differentiate between the can’t and the won’t,” Fielkow said. “With a diagnosis of ADHD, it isn’t always about discipline or having an oppositional child. It’s a medical diagnosis which requires a certain amount of patience on everyone’s part.

"Modify your expectations so that an ADHD child isn’t expected to be taken to fancy restaurants that require two hours of sitting still. Try 10 minutes at a time initially, and see how that goes," Fielkow said. "Remember, whatever system works for your child is the one you should be using.”

For more information about ADHD, go to the website for Children and Adults with Attention-Deficit Hyperactivity Disorder at: www.chadd.org or call 1-866-200-8098

--- Leslie Cardé

functional impairments change over time, because it takes time for the frontal lobe of the brain to develop.

A child diagnosed at the age of 4 can grow out of symptom impairment by the time they reach adolescence.

But, for an adolescent or adult to receive a diagnosis of ADHD, the symptoms need to have been present before the age of 12.

Dr. Susan Fielkow

The causes and progress of autism are still being studied. Here's what we know.

By Leslie Cardé | Contributing Writer

Imagine having a child who meets all of the milestones for development as an infant, but in his toddler years, everything changes.

Progress becomes regression. Verbal skills may disappear, and younger siblings may begin to pass the child in developmental markers.

It’s a familiar scenario for anyone who has raised a child who is eventually diagnosed with autism. Just why the disorder shows up so late is a question still being studied.

Neuroscientific studies out of Columbia University have told us is that children and adolescents with autism have a surplus of synapses (part of the circuitry) in the brain, due to a slowdown in a normal brain “pruning” process during development.

An increased number of synapses creates miscommunication among neurons in the developing brain, which correlates with impairment in learning.

Scientists are still studying just how this happens.

A spectrum of issues

Autism Spectrum Disorder

includes Asperger’s Syndrome, among others. There is a huge range within ASD, but everyone on the spectrum has some form of the base criteria.

“Most people on the spectrum have no intellectual disabilities but have a number of other features in common,” said Koren Boggs, PhD, clinical psychologist and team leader for the Autism Clinic at Children’s Hospital, New Orleans.

“Impairment with non-verbal communication is prevalent no matter what the disorder. It may start with not pointing to things, which is the way most children still learning language will communicate," Boggs said. "Not responding to their name is another sign. There is almost always difficulty in understanding social relationships.”

Other signs may include: inconsistent eye contact, facial expressions that don’t match what is being said, speaking in sing-song or flat robot-like tones, showing overly focused interest in specific topics or becoming upset by slight changes in routine.

On the flip side, people with autism can have many strengths, including the ability to learn things in infinite detail and retain that information for a long time. They are often strong auditory and visual learners, and can possess

excellent skills in math, science, music and art.

Although researchers don’t know the primary cause of disorders on the autism spectrum, they do know there is a strong genetic component. Those include having a sibling with ASD, having older parents, and having certain genetic conditions like Down syndrome or Fragile X syndrome.

“Fragile X is still one of the most common causes of autism,” Boggs said. “Forty-six percent of boys and sixteen percent of girls with Fragile X have some disorder on the autism spectrum. Fragile X syndrome is caused by a mutation in the Fragile X messenger gene, which makes a protein that is needed for brain development." Because the defect is on the X chromosome, autism is more prevalent in boys, who have only one X chromosome, whereas girls have two.”

The American Academy of Pediatrics recommends early screening for developmental delays at 9, 18, and 24 or 30 month intervals. ASD is a complex disorder and often occurs in tandem with other disorders, so in some cases a comprehensive evaluation may include blood tests and a hearing test. The point is to diagnose the disorder early, so treatment can begin as soon as possible.

THERAPY THAT WORKS

Helping those with autism learn new skills and improve upon their strengths at a very young age is critical to their development later on, because treatment isn’t as simple as a magic pill.

“There is no drug which is FDA-approved specifically for autism,” Boggs said. “If children with autism are given medication, it is for another disorder like anxiety or depression.”

The FDA has approved Applied Behavior Analysis therapy, which works on the core systems like communication and tolerating change. However, if an autistic child is involved in dangerous behavior like head-banging, then medication might be prescribed.

There is still a lot of controversy regarding the two approved drugs for irritability in autistic children because of the numerous and serious side effects of the antipsychotic medications, which some healthcare professionals have deemed unacceptable for children.

Research into the cause of autism is ongoing, but Dr. Boggs stressed that research indicates no link between any vaccine and autism. Autism is typically diagnosed between 2 and 3 years old, a time when children are getting vaccines. But, she notes, we don’t want to confuse correlation with causation. This is why numerous studies have been done delving into this.

When dealing with autism, concentrate on the positive aspects of the disorder. If you can take someone with a special ability and focus on that, people with autism spectrum disorders can often be successful.

If you feel you need help determining what’s best for your child, Louisiana has the “Early Steps Program”, which deals with children from birth to age 3 who have developmental delays. Go to https://ldh.la.gov/page/139 for more information.

Dr. Koren Boggs

Make ment al health partofthe conversation.

Jeremy Wigginton, M.D.

Cross and Blue Shield of Louisiana

Your ment al health is as important as your physical health. And your primarycaredoctorcan help with both. Use everyofficevisit as achancetocheck in with your doctor about howyou’re feeling.Shareifyou’re feeling stress, anxiet yordepression,soyou canget help

Othercareoptions:

•Reach outfor help throughyour EmployeeAssist anceProgram (EAP), if you have one.

•Callalocalcounseling officeand schedule an in-person appointment

•Try telehealth online appointmentswith atherapist or counselor

Blue Cross customerscan use BlueCaretelehealth services forment al and behavioral health support. With acomputer, smartphone or tablet ,customerscan meet with apsychology or psychiatryprovider who is trainedand certifiedintelehealthcare. bcbsla.com

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toget out there

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At LCMC Health, we help peopleget themost outoflife. Thatmeans keeping youwellso youcan getout and experience what lifehas to offer. It’s what drives us,throughmorethan twomillion patientvisitseach year,frombirths to surgeriestocheckupstoemergencies, from head to toe. Andwe’re notslowing down. With thousandsofhealthcareprofessionalsinnine hospitalsand dozens of clinicsand practices acrossthe NewOrleans area and beyond, LCMC Health continues to makeextraordinary careanexpectation. We’re dedicated to keepingyou,and everymember of the communitiesweserve, well.