Resilient health june 2018 by Resilient Health

A NATIONAL BEHAVIORAL HEALTHCARE SYSTEM PATIENTS TREATED:

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Issue

In this

June 2018

RESILIENT Health

MESSAGE FROM THE EDITOR Welcome to the June Issue..................................................... 4

FEATURE ARTICLES PTSD: The Brain and Psyche Rewired.................................. 5

RESILIENT HEALTH is published monthly and copyrighted by Sovereign Health, Inc., all rights reserved. Permission must be granted by the publisher for any use or reproduction of the magazine or any part thereof. Opinions expressed are those of the authors alone and do not necessarily represent the opinions, policies or positions of RESILIENT HEALTH or Sovereign Health, Inc. Â©2018, Sovereign Health, Inc. Printed in the U.S.A.

MDMA-Assisted Psychotherapy for PTSD: Symptoms Shows Promising Results..............................10 PTSD: Awareness Month .......................................................12 Brain Wellness (Part 2): What Happens To A Mistreated Brain?...........................14 Aetna Practices Latest Example of: Unethical Health Industry Ways ......................................19

Editor-in-Chief TONMOY SHARMA, MBBS, MSc

FAST FACTS: Opioid Overdose Deaths...................................................22

Communications Manager LISE MILLAY STEVENS, M.A.

Notes from ATA18: Telehealth Aims to Bring Psychiatric Services Home.......................................................24

Managing Editor EDWARD ZINTEL e.zintel@sovhealth.com

THE QUIZ CORNER: Schizophrenia Test...............................................................26

Senior Staff Writer DANA CONNOLLY, Ph.D. Graphic Designer VINOD SHARMA Content Specialist AMIT MALAVIYA

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At A Glance: Behavioral Health In The News........................................27

RESILIENT HEALTH A Behavioral Health Resource 1211 Puerta Del Sol, Suite 200 San Clemente, CA 92673 Editorial Tel: (949) 276-5553, ext. 391 Email: editor@reshealth.net Website: www.reshealth.net

MESSAGE from the Editor Welcome to the June issue of RESILIENT HEALTH! June marks the observance of PTSD Awareness Month; we’ve provided a compelling article on the biologic and psychiatric underpinnings of this complicated disorder, and current evidence-based treatment options. A complimentary article details the surprising finding that the popular club drug Ecstasy, in combination with psychotherapy, may be an option for treating PTSD. The second installment in our Brain Wellness series details key elements of patients’ brain health—adequate sleep, nutrition, exercise, positive social interaction, exposure to sunlight and avoidance of toxins—that aid in their recovery from mental illnesses and addiction. Our series of updates from ATA18 (the annual American Telemedicine Association conference) continues with a fascinating presentation from VA experts about the unique challenges of treating military personnel and the effectiveness of VTH (video-to-home) psychotherapy in this population. Death by bureaucracy. Reckless withholding of benefits. That’s what patients and their families have to say in our article about how health insurers Aetna and Centene/Health Net deny benefits to very sick subscribers of their plans. Read on to learn more about the dark side of the health insurance industry. The Quiz Corner this month provides a dozen rapid-answer questions that help your patients answer the question, “Do I Have Schizophrenia?” This quick and easy-to-administer tool may unearth a previously obscured diagnosis. Check out the Fast Facts section for a rundown on the CDC’s latest, sobering statistics on opioid overdose deaths. The numbers are staggering, a testament to the fact that there is no end in sight to the burgeoning U.S. drug epidemic. And be sure to read our At-a-Glance department this month for important news and research updates in the field. Just a reminder—there are two other important health observances for June. Men’s Health Month features the theme “Awareness, Prevention, Education, and Family.” The U.S. Congress-endorsed celebration aims to improve the health of men and boys nationwide; join the effort and find resources by visiting https://bit.ly/1pV0SAd. Join the National Safety Council and thousands of organizations nationwide for National Safety Month, which celebrates safety with the overarching theme No One Gets Hurt. The focus this year is on reducing the leading causes of injury and death at work, in the home and in communities (visit https://bit.ly/2HHmNzu). 4 RESILIENT HEALTH | June 2018

I hope you enjoy our June offering. As always, we’d love to hear from you; just email us at editor@reshealth.net. www.reshealth.net

PTSD:

The Brain and Psyche Rewired By Lise Millay Stevens, M.A.

ost-traumatic stress disorder is generally perceived as a mental disorder that occurs in combat veterans who experience the trauma of war. The truth is that PTSD can occur in any adult or child exposed to any traumatic event such as a natural disaster, serious traffic accident or the violence of rape or other physical assault. A person need not be the actual victim of the traumatizing event; simply witnessing one can lead to the development of PTSD. Not surprisingly, veterans, rescue workers and emergency medical personnel–individuals whose work commonly entails exposure to disturbing events–are particularly www.reshealth.net

susceptible to developing PTSD, as are children exposed to sexual abuse or domestic violence.

Fight or Flight It is natural to feel afraid during a stressful situation—fear triggers instant changes in the brain that help humans defend against danger (fight) or avoid it (flight). The “fight or flight” response exists in virtually all living things to guard against injury or being killed. Stress reactions such as a pounding heartbeat, anxiety and panic help humans and other animals react to danger quickly to save themselves or confront the threat at hand. Once the emergency has ended, most people feel relief and, often,

some lingering anxiety and fear that gradually fade away. But in patients with PTSD heightened stress responses linger and intensify, causing uncontrollable and emotionally crippling symptoms for many months or even years after the trauma occurs. As mentioned, it is normal for a person exposed to traumatic events to have some lingering symptoms for a time, or even develop short-term acute stress disorder. In these cases, the symptoms will lessen and eventually resolve in a matter of weeks or months. A diagnosis of PTSD entails more enduring symptoms, including: RESILIENT HEALTH | June 2018 5

Re-experiencing: Reliving the trauma repeatedly in flashbacks, physical symptoms such as a racing heart and sweating, nightmares, and frightening thoughts and feelings. These re-experiencing symptoms can disrupt a patient’s daily routines and ability to function. Seemingly random words, objects or situations can trigger a re-experiencing event. Avoidance: Patients with PTSD may show avoidance behaviors, such as keeping their distance from objects, experiences and places that remind them of the triggering event (for example, refusing to ride in/drive a car after exposure to a traffic accident). They might also avoid feelings or thoughts related to the event (for example, being unwilling to watch a movie featuring cars or driving). Arousal and Reactivity: These symptoms in patients with PTSD involve being easily startled, feelings of being tense and edgy, difficulty sleeping and angry outbursts. The behavior is generally consistent rather than being triggered by a reminder of the traumatic episode. Arousal and reactivity symptoms interrupt daily activities such as sleeping, concentrating on routine tasks, and eating. Cognition and Mood: Cognitive and mood symptoms typically include difficulty remembering the traumatic event, feelings of guilt or blame, loss of interest in activities that were previously enjoyable, and negative feelings about the world and oneself. Patients may manifest all or most of the above symptoms, or just a few from each category. 6 RESILIENT HEALTH | June 2018

Regardless, the National Institute of Mental Health’s guidelines indicate that a diagnosis of PTSD requires, at minimum, the recurrent presence of 1 re-experiencing symptom, 1 avoidance symptom, 2 arousal symptoms and 2 cognition/mood symptoms.

PTSD: Psychology or Physiology? Initially, PTSD was conceived as a purely psychological response to

trauma. The American Psychiatric Association added PTSD to the DSMV III in 1980 in the wake of clinical studies and reports in the 70s on a cluster of symptoms specific to Vietnam combat troops. But the concept was not a new one; in 1915, the term “shell shock” was coined to describe similar symptoms in World War I servicemen, especially those who were subjected to repeated bombardment from enemy fire. But with advances in neurology and brain imaging, researchers have shown that brain function is altered in people with PTSD, within three main areas of the brain:

1. The amygdala is an area of the brain key in regulating emotions, especially fear. 2. The ventromedial prefrontal cortex (vmPFC) area controls higher functions, such as emotional processing and decision-making. 3. The hippocampus, the largest area of the three discussed herein, is involved in memory— especially spatial memory of places.

In people with a normal response to dangerous cues from their environment–for example, seeing a shark in a tank at the aquarium– the amygdala becomes active, sending fight or flight messages to other areas of the brain. At that moment, the “higher thinking” vmPFC communicates to the amygdala that the shark is contained, no need to worry. The hippocampus supports the amygdala by providing context such as “you recognize this setting; you are at the aquarium.” These processes allow the vmPFC to inhibit the fearful impulses of the amygdala. www.reshealth.net

Conversely, in people with PTSD, brain imaging studies show that the vmPFC is underactive, which allows the unfettered amygdala to produce the uncontrollable and intense panic and anxiety so common in the disorder. The exact reason for this brain imbalance is not known. Research has shown, however, that extremely stressful events (war, witnessing terrible events, sexual assault) results in acute and chronic changes in neurochemical systems such as the stress response brain chemicals cortisol and norepinephrine. Changes in specific brain regions and chemistry result in alterations in the workings of brain circuits involved in reasoning, stress responses and memory.

Treatment Approaches The first task is to ascertain that your patient is indeed suffering from PTSD and not a different mental disorder (for information on PTDS and differential diagnosis, visit https://bit.ly/2J8jBwx). Screen for dual-diagnoses; many patients with PTSD will have a co-occurring condition such as substance use, depression and/or suicidal ideation (for a comprehensive list of diagnostic tools, visit https://bit. ly/2sjHR4D).

patients about trauma and its effects; provide relaxation and anger-control skills; tips on improving diet, sleep and exercise habits; address feelings of guilt, shame and blame surrounding the traumatic event; and change reactions to PTSD symptoms. CBT therapies may include exposure therapy/prolonged exposure therapy to help patients control the symptoms caused by fear. Employing mental imagery, writing exercises and revisiting the place where the trauma occurred can all help patients to overcome or tolerate distressing emotions and reminders. Cognitive processing therapy can help patients gain control over disturbing thoughts and learn how their traumatic experience changed them and their world view. Doing so enables them to gain insight into their emotions and behavior. The use of eye movement desensitization and reprocessing therapy (EMDR) makes use of rapid and rhythmic eye movements to stimulate the brain while revisiting

the traumatic event. EMDR can unlock negative emotions to help patients develop coping mechanisms. For children and adolescents, trauma-focused CBT (TF-CBT) is an effective approach for young people exposed to a wide-array of traumas, including war, domestic violence, traumatic loss and the complexities of surviving foster care. However, this type of therapy should only be provided by a TFCBT certified therapist. For more on this approach, visit https://bit. ly/2xcP3F7. A wide array of medications for patients with PTSD have been proven effective. Certain drugs can help them manage problems with addiction, sleep disturbances, depression, anger, anxiety, despair and loss of control. The National Institute of Mental Health’s comprehensive list of medications can be found at https://bit. ly/2lv5cLV. Complimentary therapies often help patients with PTSD to recover, including family therapy, mindfulness training, meditation

As is true of all behavioral health treatments, there is no single one-size-fits all approach to treating PTSD. Research shows, however, that the best evidencebased treatments for PTSD include psychotherapy, medications, or a combination of both, specifically: Cognitive behavioral therapy, which can help to identify the events, situations and objects that trigger symptoms, and how to address these triggers. In addition, CBT can help educate www.reshealth.net

RESILIENT HEALTH | June 2018 7

and yoga, companion dog and horse therapy, and self-expression through art or writing assist patients to find positive outlets for their emotions. Connecting with new and old friends, socializing with others who have experienced a similar trauma and volunteering create support networks and reconnection to their communities. PTSD is a multi-faceted and debilitating condition that wreaks havoc on the psyche and the brain’s circuitry. With compassionate and evidence-based care provided by an experienced professional, however, people can and do recover every day.

Sources Bremner DJ. Post-traumatic stress: Effects on the brain. Dialogues Clin Neurosci. 2006;8:445-461. https://bit.ly/2ewAp0F National Institute of Mental Health. PostTraumatic Stress Disorder. Bethesda; MD: Revised February 2016. https://bit. ly/2dJ6R0F Newton P. The anatomy of posttraumatic stress disorder. Psychology Today. January 29, 2009. https://bit.ly/2s8GyWQ

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Lise Millay Stevens is a writer, editor and medical/ public health professional who has held senior-level positions on the communication teams at the New York City Department of Health and the American Medical Association. She leveraged her modern language skills (Bachelor’s of French; Master’s in Spanish) to learn the language of medicine and science. Her graduate journalism studies at Roosevelt University and work in the AMA’s press office sparked her passion in writing accurate and accessible health-related stories. A transplant from Brooklyn, Lise is a card-carrying member of the New York City Press Club who currently lives in Cleveland, Ohio, with two whiskered, furry, four-footed companions. She currently serves as Communications Manager at Sovereign Health.

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SPECIAL SECTION

Treating Substance Use Disorders:

A Resolution to Embrace Measurement-Based Care Why Measuring Treatment Outcomes is a 21st Century Mandate for Treating Addiction

e are well into the second decade of the 21st century. On almost a weekly basis, new discoveries gleaned from advanced neuroimaging techniques, rigorous clinical trial outcomes data, and the development of novel neuropsychiatric medications are opening new pathways in addiction treatment. Individuals with substance use, and those with the comorbidities of addiction and an underlying psychiatric condition, should be reaping the beneﬁts of evidence-based addiction treatment. But sadly, data show that health care professionals are not implementing evidence-based science (Scott & Lewis, 2015) in treating the 21.5 million Americans who have a substance use disorder (SAMSHA, 2016).

Dr. Tonmoy Sharma, MBBS, MSc CEO, Sovereign Health

of symptoms, and empowers patients to participate in their own care while improving their outcomes (Lambert et al.; 2005).

n 2015, the Kennedy Forum released an Issue Brief titled “Fixing Mental Health Care in America: A National Call for Measurement-Based Care in the Delivery of Behavioral Health Services,” which illustrated the domino eﬀect caused by a

espite the deleterious effects of not implementing an MBC model, clinicians have been slow to change. It is worth noting that, in general, it takes 17 years for 14 percent of research to reach consumers (Balas & Boren; 2000). In addition, clinicians have negative perceptions about MBC, including that the burden of training themselves and their staffs is too onerous, negative feelings about prescribed manuals and protocols, and a belief that specific evidence-based practices may not be appropriate for their clients and their practice settings (Scott & Lewis, 2015).

e know that quality health care, including substance use and addiction care, should be ﬁrmly rooted in established biomedical research. Measurement-based care (MBC) — the practice of basing clinical care on client data collected throughout treatment (Scott & Lewis, 2015) — is a core component of evidence-based practices (Klerman, Weissman, Rounsaville & Chevron, 1984; Beck & Beck, 2011). Over the past decade, MBC has emerged as an incontrovertible, evidence-based method that can be used for virtually any health issue (Lambert et al., 2003; Trivedi et al., 2007), and research has shown that applying MBC (such as monitoring symptom change using idiographic assessments) is beneﬁcial for improving client outcomes (Weisz et al., 2011). Overall, MBC elucidates treatment progress, allows for adjusting treatment plans as necessary, reduces exacerbation

services. Providers and, indeed, entire health care systems miss opportunities for ongoing improvement. A lack of symptom rating scales precludes individual practices and health care networks from proving the eﬃcacy of their treatment protocols to third-party payers. This lack of empirical data on treatment success leads to chronic federal and state underfunding of behavioral health treatment, and decisions about reimbursement for services rendered are not aligned with treatments that are proven to be the most beneﬁcial (Kennedy Forum, 2015).

non-MBC approach in behavioral treatment. The conclusions are mind-boggling; per the Brief, a mere 18 percent of psychiatrists and 11 percent of psychologists monitor the eﬃcacy of speciﬁc treatment approaches by routinely administering symptom rating scales and therapist assessments to their patients. This lack of assessment cements clinical inertia, and creates barriers to improving clinical

iven the stakes, we cannot accept that these perceived barriers to MBC are insurmountable, unresolvable or even valid. A lack of evidence-based treatment spells failure for clinicians, institutions, health care networks and, most importantly, our patients. Let us resolve to embrace our brave new world of clinical innovations and scientific advances that enable us to provide the best measurement-based care for substance use and addiction treatment.

References

Balas, E. A., & Boren, S. A. (2000). Managing clinical knowledge for health care improvement. Yearbook of Medical Informatics, 65–70; Beck J.S., Beck A.T. (2011). Cognitive behavior therapy: Basics and beyond. New York: Guilford Press; Kennedy Forum (2015). Fixing Behavioral Health Care in America: A National Call for Measurement-Based Care in the Delivery of Behavioral Health Services; http:// thekennedyforum-dot-org.s3.amazonaws.com/documents/KennedyForum-MeasurementBasedCare_2.pdf; Klerman G.L., Weissman M.M., Rounsaville B.J., Chevron E.S. (1984). Interpersonal psychotherapy of depression. New York: Basic Books; Lambert, M. J., Whipple, J. L., Hawkins, E. J., Vermeersch, D. A., Nielsen, S. L., & Smart, D. W. (2003). Is It time for clinicians to routinely track patient outcome? A meta-analysis. Clinical Psychology: Science and Practice, 10, 288–301; Lambert, M. J., Harmon, C., Slade, K., Whipple, J. L., & Hawkins, E. J. (2005). Providing feedback to psychotherapists on their patients’ progress: Clinical results and practice suggestions. Journal of Clinical Psychology, 61, 165–174; Scott K., Lewis C.C. (2015). Using Measurement-Based Care to Enhance Any Treatment. Cognitive and Behavioral Practice, 22:49-59; Simons, A. D., Rozek, D. C., & Serrano, J. L. (2013). Wanted: Reliable and valid measures for the science of cognitive behavioral therapy dissemination and implementation. Clinical Psychology: Science and Practice, 20, 181–194; Substance Use and Mental Health Services Administration (2016). Mental and Substance Use Disorders. SAMSHA; Rockville, MD. https://www.samhsa. gov/disorders; Trivedi, M. H., Rush, A. J., Gaynes, B. N., Stewart, J. W., Wisniewski, S. R., Warden, D., … Howland, R. (2007). Maximizing the adequacy of medication treatment in controlled trials and clinical practice: STAR*D measurement-based care. Neuropsychopharmacology, 32, 2479–2489; Weisz, J. R., Chorpita, B. F., Frye, A., Ng, M. Y., Lau, N., Bearman, S. K., … Hoagwood, K. E. (2011). Youth Top | www.reshealth.net RESILIENT HEALTH June 2018 9 of Consulting and Clinical Psychology, 79, 369. Problems: Using idiographic, consumer-guided assessment to identify treatment needs and to track change during psychotherapy. Journal

MDMA-Assisted Psychotherapy for PTSD

Symptoms Shows Promising Results By Resilient Health Staff

he synthetic drug 3,4-methylenedioxymethamphetamine (MDMA; aka, Molly, Ecstasy, X) is an illicit synthetic drug that alters mood and perception (awareness of surrounding objects and conditions). MDMA is chemically similar to both stimulants and hallucinogens, producing feelings of increased energy, pleasure, emotional

warmth and distorted sensory and time perception. The drug commonly is associated with raves, dance parties and nightclubs. Considering its negative aspects, it’s hard to imagine it as a therapeutic drug for a serious mental disorder like post-traumatic stress disorder (PTSD). However, according to a randomized controlled trial by a group of

10 RESILIENT HEALTH | June 2018

American researchers, ecstasy could be used for treating PTSD. The study, published in The Lancet Psychiatry in May 2018 (https://bit.ly/2IdVM5U), showed that Molly, in combination with psychotherapy under supervised care at certified drug abuse centers, can be an effective tool to treat PTSD symptoms in veterans and first responders.

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Used illegally by millions across the United States, ecstasy can reduce inhibitions and promote feelings of euphoria among its users. When taken for longer periods of time, its use can lead to psychological and physical dependence.

Improvements in PTSD symptoms recorded The researchers performed a randomized trial on 26 people, including armed service personnel, firefighters and a police officer at an outpatient psychiatric clinic in the United States. The participants were aged 18 years or older and were assigned to different groups of MDMA doses comprising 30 mg, 75 mg or 125 mg. Both the participants and the therapists were unaware of the strength of the dose administered. The drug was administered orally in two 8-hour sessions along with manual psychotherapy sessions. Participants received psychotherapy before the MDMA dose was administered, eight hours after the dose, as well as in the weeks that followed. All the participants were analyzed 12 months after their last MDMA session. The researchers observed mean change in Clinician-Administered PTSD Scale (CAPS-IV) scores. According to the researchers, there was a mean change in the participants’ CAPS-IV score after the second experimental session. The participants in the 75 mg and 125 mg dose groups reported a greater improvement in the PTSD symptoms. Additionally, the participants in the 30 mg and 75 mg groups were subsequently given three 100-125 mg MDMA doses along with psychotherapy sessions. While the study www.reshealth.net

participants reported a few side effects, they were minor and appeared only in the days following the MDMA dose.

MDMA should not be used to self-medicate PTSD

People with PTSD may become emotionally numb, aggressive, lose interest in things they once enjoyed or may even avoid situations that remind them of the traumatic event. Mental illnesses can affect anyone, including children, war veterans and anyone who has been through a dangerous event or has

numb, aggressive, lose interest in things they once enjoyed or may even avoid situations that remind them of the traumatic event. Mental illnesses can affect anyone, including children, war veterans and anyone who has been through a dangerous event or has suddenly lost a loved one. Unfortunately, many PTSD patients self-medicate with hallucinogens like MDMA. According to the 2016 National Survey on Drug Use and Health, approximately 1.4 million people, aged 12 years and older, were current users of hallucinogens, including Molly, LSD, PCP, Salvia, ketamine, peyote, magic mushrooms, mescaline and DMT/ AMT in the past year. Ecstasy procured from the street can have an unknown mix of stimulants, which may lead to brain damage, overdose or even death.

Ecstasy addiction can be cured Addiction to MDMA can lead to health effects like nausea, blurred vision, cramped muscles, chills and sweats, among others. However, one can recover from drug dependence through specialized care at a residential addiction treatment center.

suddenly lost a loved one.

An individual may develop PTSD after experiencing or witnessing a traumatic life event. People with PTSD may become emotionally RESILIENT HEALTH | June 2018 11

Raise PTSD Awareness You can make a difference! “Greater understanding and awareness of PTSD will help Veterans and others recognize symptoms and seek and obtain needed care.” – Dr. Paula P. Schnurr, Executive Director of the National Center for PTSD

he National Center for PTSD promotes awareness of PTSD and effective treatments throughout the year. Starting in 2010, Congress designated June 27 as PTSD Awareness Day (S. Res. 541). In 2014, the Senate designated the full month of June as National PTSD Awareness Month (S. Res. 481). After a traumatic event, most people have painful memories. For many

people, the effects of the event fade over time. But for others, the memories, thoughts and feelings don’t go away--even months or years after the event is over. Mental health experts are not sure why some people develop PTSD and others do not. If stress reactions do not improve over time and they disrupt everyday life, it’s important to seek help to determine if PTSD is present. The purpose of PTSD Awareness Month is to encourage everyone to raise public awareness of PTSD and effective treatments. We can all help those affected by PTSD.

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Commitment to Veterans and Others The Veterans Administration provides effective treatment for our nation’s veterans and conducts research on PTSD, including the prevention of stress disorders. The campaign supports veterans, their families, and all those who have experienced trauma to get care. Be a part of PTSD Awareness Month. For more information, go to www.ptsd.va.gov.

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S E RV I C E S O F S OV E R E I G N H EA LTH

Addiction / Dual Diagnosis Sovereign Health is a leader in the treatment of addiction, mental health disorders and dual diagnosis. Dual diagnosis refers to a mental health condition and substance abuse occurring simultaneously. Sovereign believes that addiction is a chronic brain disease that may include periods of relapse. It is important to note that repeated relapses after periods of sobriety may indicate the presence of an underlying disorder requiring professional treatment.

Treatment Programs Offered:

At Sovereign Health, we specialize in the complex assessment and multidisciplinary care required to successfully treat patients who are struggling with dual diagnosis. Our behavioral health team of masterand doctoral-level therapists are uniquely qualified to treat the mental health conditions that often accompany substance abuse.

• Detoxification

We attribute much of our success to the holistic approach we employ with each individual patient. Multidisciplinary aspects of care are all interrelated and each person has different needs. From arrival to discharge, our treatment team includes each dual diagnosis patient in all decision-making related to his or her own plan of care.

• Telehealth

Patients Served • Adolescents • Adults • Males, Females and Transgender

Levels of Care • Detoxification • Residential Treatment • Partial Hospitalization • Intensive Outpatient • Outpatient • Recovery Management

For more information, please visit

www.sovhealth.com www.reshealth.net

• Primary Mental Health • Substance Use • Dual Diagnosis • Eating Disorders • Pain Recovery • CROSS: Christian Recovery Offering Significant Success • POWER: Primary Opportunities for Women Experiencing Recovery • PRIME: Personal Recovery Integrating Men’s Experiences

24/7 ADMISSIONS HELPLINE

888.701.7488

RESILIENT HEALTH | June 2018 13

Adequate sleep, nutrition, exercise, positive social interaction, exposure to sunlight and avoidance of toxins‒all aspects of a healthy lifestyle.

Brain Wellness (Part 2):

WHAT HAPPENS TO A MISTREATED BRAIN? By Dana Connolly, Ph.D.

n the first part of this brain wellness series, we reviewed brain structure and function, including the key elements required to maintain brain wellness. These elements include adequate sleep, nutrition, exercise, positive social interaction, exposure to sunlight and avoidance of toxins‒all aspects of a healthy lifestyle. But what happens when the brain is deprived of these key elements or is exposed to toxic elements on a regular basis? Our second installment of the series this month is dedicated to the pathophysiology of the mistreated brain, and how to diagnose and treat common clinical manifestations caused by unbalanced or unhealthy lifestyles.

Pathophysiology of Mental Illness Mental illness is extremely common in the United States; nearly 50 percent of all Americans experience a mental disorder at least once in their lifetime. Risk factors include a family history of mental issues and adverse conditions, including environmental toxins, socioeconomic adversities, trauma, other illnesses and abuse. Drug and alcohol use can be a risk factor for, or a symptom of, mental illness. For a detailed discussion on risk and protective factors, visit https://bit.ly/2HOYL0w. The pathophysiology of mental illness involves derangements in the complex neurobiological

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structures and networks discussed in Part 1 of this series. This process involves malfunctions in brain tissue, electrochemical signaling and silencing along with neural circuit functioning. Recent advances in cognitive neuroscience, brain imaging and epigenetics (turning genes on and off) are changing the way researchers approach the diagnosis and management of mental illnesses. But these disorders can manifest on every level, from molecules to consciousness. So, despite our complex and detailed knowledge of neurobiology, we cannot directly translate this information into concrete clinical psychiatric practices. Consciousness is too subjective, and the nature of human experience is too broad. www.reshealth.net

When mental illness does manifest, there are specific emotional symptoms, behavioral indicators and physical signs of lifestyle imbalance that steer the skilled clinician to the correct diagnosis(es). Symptom severity can be quantified using measurement-based care (MBC) to aid in assessment, modifying treatment and measuring outcomes. The standardized questionnaires used to this end are based on diagnostic criteria found in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. (We’ll discuss MBC in more detail later in this series.)

Clinical Manifestations of Mental Illnesses The most common clinical manifestations of the mistreated brain are anxiety and depression. The key moderating factors that determine whether mental illness will reach a clinical threshold are stress (perceptions of severity) and coping (behavioral responses). For example, a person with a balanced lifestyle who gets laid off may experience moderate stress, but copes by increasing exercise and positive social interactions while maintaining other key elements of brain wellness. Another person in the same situation, however, may cope by isolating herself, staying up all night worrying, or turning to drugs or alcohol for relief. This individual is far more likely to develop mental illnesses and/or other problems linked to substance use. (See the following illustration of where the stress response occurs in the brain). www.reshealth.net

After depression and anxiety, the most common forms of mental illness are trauma-related disorders, obsessive-compulsive disorders, phobias, bipolar illness, personality disorders and psychosis. Behavioral disorders, such as eating disorders and addiction, go hand-in-hand with mental disorders and can occur as a direct result of behavioral problems or because of them (such as selfmedicating with drugs and alcohol).

The Profound Effect of Lifestyle on the Brain The way individuals cope with stress is directly related to their lifestyle habits. Habits and coping strategies largely determine whether a person will be resilient to or vulnerable to stress. Maladaptive stress responses, such as drinking too much or avoiding friends, increase anxiety and depression, which in turn may trigger maladaptive behavior. The result is a vicious cycle that increases the risk of behavioral health disorders, as shown in the flowchart below:

However, maladaptive behaviors are not set in stone and can be prevented, managed or even cured by attending to the brain’s needs daily, allowing it to function properly.

Adequate Sleep Getting sufficient sleep is essential for brain wellness. Each phase of sleep serves a function for information processing, rest and healing. Chronic sleep deprivation has detrimental effects on the brain and other organs (see the figure below).

RESILIENT HEALTH | June 2018 15

Common causes of insomnia and sleep deprivation include poor “sleep hygiene,” anxiety, substance use, environment and mental illness. Good sleep hygiene consists of healthy habits that are conducive to quality sleep and regular sleep times. For example, avoiding caffeine and electronic devices prior to getting into a clean, comfortable bed before turning out the light is good sleep hygiene. Avoiding long-term use of sleep medication is essential because such medications disrupt sleep quality by preventing normal phases of sleep. Also, even over-the-counter sleep medication can be habitforming and lead to memory loss and dementia.

Nutrition Unfortunately, the typical American diet consists largely of foods from boxes, cans, jars and packages, all of which contain many mysterious ingredients that are difficult to pronounce. Many Americans substitute fast foods for home-cooked meals, washing them down with bubbly chemical beverages. While this is unhealthy for anyone, it is particularly dangerous for people with mental health and substance use issues. Focusing diet on consuming essential nutrients, on the other hand, helps to restore neurotransmitters in the brain, which improves mood and cognitive function. But what is a healthy diet? Nutrition experts at Yale University compared common types of diets – such as low fat, low carbohydrate, etc. – to see which ones were the healthiest. While no single diet was superior, the researchers stated, “…a diet of minimally processed foods

close to nature, predominantly plants, is decisively associated with health promotion and disease prevention.” A healthy diet includes: • Mainly vegetables, fruit, legumes, whole grains, seeds, nuts, herbs and spices • Variety • Multiple colors • Lean meat and fish • Eggs and dairy • Nothing artificial, processed, fried or with added sugar or sugar substitutes For individuals recovering from addiction, a healthy diet can also help to maintain sobriety by reducing or eliminating cravings for drugs and alcohol. Avoiding sugary foods and beverages prevents stimulation of addiction receptors in the brain. In addition to consuming a nutritious diet, people in recovery benefit from avoiding a few dietary no-no’s: • Avoid or minimize caffeine intake, as it mimics the effects of neurotransmitters • Avoid fasting, as hunger can trigger cravings • Eliminate refined sugar, as it also stimulates addiction receptors • Minimize intake of simple carbohydrates such as white bread, pasta, white rice and bakery products; the body converts these foods into sugar, a stimulator of addiction receptors Remember, patients should consult with a health care provider before starting a new diet, including taking nutritional supplements such as vitamins and mineral products.

16 RESILIENT HEALTH | June 2018

Exercise The importance of exercise for brain wellness cannot be understated. Daily exercise is a well-established treatment for patients with depression, anxiety, psychosis and mood disorders, and those who are recovering from addiction. A review of the literature suggests exercise also decreases craving and drinking in patients with substance use disorders. Exercise increases oxygen delivery to the brain, liver and heart, which promotes healing and prevents disease. Endorphins released during exercise improve mood and decrease anxiety. Outdoor exercise is optimal to prevent vitamin D and magnesium deficiency; both nutrients are required for normal brain function. But how much exercise is needed to achieve these effects? See the infographic on page 17 for basic recommendations on a healthy exercise routine.

Positive Social Interaction Humans cannot thrive in isolation. There is overwhelming evidence that positive supportive social groups are essential for normal growth and development, and contribute to longevity. Socializing helps people process stress and buffer adversity. Add a dash of laughter as it has been shown to improve cognitive function and overall feelings of wellbeing. Maybe it really is the best medicine. The importance of having a social life and support groups for people recovering from addiction was illustrated in a 1999 study www.reshealth.net

published in The American Journal of Drug and Alcohol Abuse. The research examined qualities of support groups whose members had the lowest relapse rates over two years. The most successful group members had formed friendships that extended beyond the group and participated in group special events and activities such as outreach, volunteering and fundraising.

Toxins While avoiding toxins may sound simple, it is not; they are everywhere, in our air, water and food. There is evidence that invisible radiation from the environment, including electromagnetic radiation from WiFi and electronics, can be harmful. Many of these elements are an unavoidable part of daily life, but patients can be counseled to avoid chemical exposure from smoking, vaping, taking drugs and drinking alcohol. Mind-altering drugs damage the brain and nervous www.reshealth.net

system and permanently affect neural networks. Fortunately, these effects can be overcome with abstinence and evidencebased treatment.

“We are what we repeatedly do. Excellence is not an act, but a habit.”

—Will Durant (U.S. American writer, historian and philosopher)

Conclusion Fortunately, the human brain is just as simple as it is complex. The master organ needs an adequate amount of a few simple things daily to function properly. When the brain is mistreated, it becomes ill. The first line of treatment, therefore, is to restore homoeostasis by increasing the healthy lifestyle habits the brain needs. Doing so not only improves mental health and overall wellbeing, but it prevents physical illnesses as well. Even under the best circumstance, however, mental illnesses and addiction can develop that require professional treatment. Reminding patients that caring for their bodies will help their brains can improve outcomes and even accelerate recovery.

About the Author Dana Connolly, Ph.D., is a senior staff writer for Sovereign Health. She earned her Ph.D. in research and theory development from New York University and has decades of experience in clinical care, medical research and health education. For more information, inquiries or to comment on this article, contact the author at news@sovhealth.com.

RESILIENT HEALTH | June 2018 17

PRIME Program

P RO G R A MS O F S OV E R E I G N H EA LTH

Sovereign Health

PRIME Program for Men Sovereign Health offers specialized residential addiction treatment for men 40 to 65 years of age through our Personal Recovery Integrating Men’s Experiences (PRIME) Program. PRIME is a 45 - to 60-day program that includes all levels of care, from detoxification to outpatient treatment. This holistic program focuses on the psychosocial, physical and financial health issues facing mature men in the “prime” of their lives. PRIME helps men establish sober and supportive relationships, manage medical conditions and create new employment opportunities. We attribute much of our success to our recognition that developmental issues vary across the life span. Our treatment program is based on an appreciation that men in their 40s and older face unique challenges. Employing research in the areas of neurobiology and developmental psychology, PRIME is designed to facilitate recovery and healing from arrival to discharge. Patients Served • Men in their 40s, 50s and 60s • Men whose careers, families and relationships have been affected by alcohol or drug use • Men requiring maximum anonymity

Levels of Care • Detoxification • Residential Treatment • Partial Hospitalization • Intensive Outpatient • Recovery Management

For more information, please visit

www.sovhealth.com 18 RESILIENT HEALTH | June 2018

Treatment Programs Offered: • Detoxification • Primary Mental Health • Substance Use • Dual Diagnosis • Telehealth

24/7 ADMISSIONS HELPLINE

888.701.7488 www.reshealth.net

Aetna Practices Latest Example of

Unethical Health Industry Ways By Lise Millay Stevens

here’s something rotten in Denmark. Maybe it’s wafting over from the U.S. health insurance industry. CNN reports that a former Aetna medical director admitted, under oath, that he never looked at patient records prior to approving or denying care, relying instead on the recommendations from nurses at the insurance giant. The admission from physician Dr. Jay Ken Iinuma emerged in his deposition in response to a lawsuit from patient Gillen Washington, www.reshealth.net

who sued Aetna for breach of contract and bad faith after the insurer refused to pay for his expensive infusions for a rare medical condition. Mr. Washington alleges that the “reckless withholding of benefits almost killed him,” CNN reports.

records, that’s of significant concern to me as insurance commissioner in California—and potentially a violation of law.” The commissioner opened an investigation into Aetna’s practices after CNN brought the case to his attention.

The network brought the case to the attention of California Insurance Commissioner Dave Jones, who commented, “If the health insurer is making decisions to deny coverage without a physician actually ever reviewing medical

In the same report, CNN states that Aetna defended Dr. Iinuma, saying in its legal brief that he relied on his “years of experience” as a trained physician in making his decision about Washington’s treatment, and that the doctor followed Aetna’s Clinical Policy Bulletin appropriately.

RESILIENT HEALTH | June 2018 19

Aetna also alleged that Mr. Washington had missed appointments for bloodwork related to his condition. But that doesn’t explain why Aetna’s medical director was not reviewing patient cases before denying coverage. According to CNN, Iinuma, who signed Mr. Washington’s preauthorization denial, said during his videotaped deposition that he never read Washington’s medical records and knew next to nothing about his disorder. Unfortunately, refusing to pay for insured patients’ treatment is not unusual in California and elsewhere. A case is pending against Health Net (currently a subsidiary of Centene Corp.) for unlawfully refusing to pay millions of dollars in claims to treatment centers in Arizona and California, according to the website of law firm Gallagher & Kennedy. According to the California complaint, Health Net “…began categorically denying substance abuse claims submitted by California treatment centers. The claim denials were done via form letters signed by Matthew Wong, M.D.” The complaint also asserts, “The claim denials based upon lack of medical necessity contained no distinction based upon the type of substance abuse or any other key details surrounding treatment.” And a Health Net clerk, Matthew Ciganek, was “robo-signing medical necessity denials, regardless of the underlying treatment details,” the complaint alleges.

Inadequate Health Networks Centene/Health Net is no stranger to accusations of bilking both providers

and subscribers alike. In January 2018, the company made the news when a lawsuit filed in Washington state alleged that customers in 15 states who purchased Centene insurance via the Affordable Care Act exchanges could not find in-network doctors and hospitals. According to the lawsuit, “Centene misrepresents the number, location and existence of purported providers by listing physicians, medical groups and other providers—some of whom have specifically asked to be removed—as participants in their networks and by listing nurses and other nonphysicians as primary care providers.” Former Congresswoman Donna Christensen, in a recent opinion piece in the Washington Examiner on “narrow” networks, commented that as Centene/ Health Net has expanded into markets that other insurance companies have abandoned, “the company is taking advantage of vulnerable Americans, falsely touting an adequate provider network when the actual plans are so skimpy that many critics question whether they even meet minimum coverage requirements.” She added, “This practice completely violates consumers’ rights.” Ms. Christensen currently serves on the board of Consumers for Quality Care.

Death by Bureaucracy In another California lawsuit filed against Health Net in 2017, the family of a woman who died awaiting a liver transplant alleged that she was the victim of Health Net’s disregard for her ailing health, according to a report in the Daily Breeze. When Health Net had no in-network provider qualified to perform the transplant, the insurer dithered for months, allegedly

20 RESILIENT HEALTH | June 2018

searching for an out-of-network liver transplant specialist. The woman died before she even had a transplant consultation. According to the news report, her family’s attorney, Travis Corby commented, “No person in this country should be forced to wait months just to receive an initial consultation for life-saving treatment. [She] died without even having a chance at receiving the care she deserved.” Mr. Corby added, “HMOs like Health Net…should not be permitted to make patients wait in perilous condition while it spends months ‘negotiating’ a contract and looking to save itself money on care that should be immediately available to its insureds,” Corby added. “It is death by bureaucracy.” The great irony is that Centene has been making billions of dollars in profits off Obamacare and other plans (the company posted a whopping $239 million profit in the third quarter of 2017 alone, up 22 percent from the same period the previous year). The company’s stock has been a hot commodity in recent months. Their CEO, Michael Neidorff, is the highest paid executive in the industry, raking in nearly $22 million in 2016, $411,800 of which was received as stock options and $12,829,500 as stock, according to salary.com. The rich get richer while the insured get sicker. Is this the health care America deserves? When even having insurance means there is no available networks, claims are denied, procedures delayed… and patients die? It is time to hold insurers accountable. Healthy Americans are money in the bank.

www.reshealth.net

FAC I L I T I E S O F S OV E R E I G N H EA LTH

Sovereign Health of Rancho San Diego San Diego, California Sovereign Health of Rancho San Diego is designed specifically to treat adolescent and teen patients struggling with substance use, mental health disorders and behavioral problems. Our residential facility is staffed by a compassionate and multidisciplinary treatment team who are trained to work with adolescents through every step of their treatment. Upon admission, our clinicians diagnose any underlying condition which may be present such as anxiety or depression. After a thorough assessment, patients are given a customized treatment plan to achieve the most successful outcomes. The San Diego facility sits on 25 acres of mountainous landscape with green belts and trees surrounding the property. It is the perfect place for adolescent patients to recover in a safe, tranquil and rural location. Accredited by the Joint Commission, our program utilizes evidence-based treatment modalities combined with a holistic focus for a well-balanced recovery. In addition, the San Diego facility holds a Community Care License from the Department of Social Services. Our licensed clinicians and multi-disciplinary medical professionals use several approaches to combat each presenting condition. Patients Served • Males and Females • 12 – 17 Years Old

Levels of Care • Residential Treatment • Partial Hospitalization • Intensive Outpatient • Recovery Management

For more information, please visit

www.sovteens.com www.reshealth.net

Treatment Programs Offered: • Adolescents Only • Primary Mental Health • Substance Use • Dual Diagnosis • Telehealth • Eating Disorders • Gender Diversity & Transgender Identity Service

JOINT COMMISSION ACCREDITED

24/7 ADMISSIONS HELPLINE

888.701.7488

RESILIENT HEALTH | June 2018 21

Opioid Overdose Deaths

new report from the Centers for Disease Control and Prevention says opioids are a factor in twothirds of the accidental overdose deaths in the United States. At a time when the country seems hopelessly divided, health officials remind us of something that unites Americans from all walks of life: deaths tied to opioid overdoses. A recent report issued by the Centers for Disease Control and Prevention presents some alarming new statistics about the opioid epidemic that claim the opioid epidemic is evolving:

42,249

The number of accidental opioid overdose deaths in the United States in 2016. That figure represents 66 percent of all drug overdose deaths that year.

13.3

The age-adjusted rate of opioid overdose deaths in 2016. That means that for every 100,000 Americans, 13.3 died from taking a powerful dose of opioids. By adjusting for age, researchers can

estimate how many deaths there would have been if every state had the same age distribution of residents. Then they can make comparisons between states that skew younger and states with a higher proportion of elderly people.

27.9%

That’s how much the opioid overdose death rate increased in just one year, between 2015 and 2016. In 2015, there were 10.4 opioid overdose deaths per 100,000 people.

56.1%

The increase in fatal opioid-related overdoses among Americans categorized as non-Hispanic blacks between 2015 and 2016. That was the biggest increase seen in any racial or ethnic group. Asians and Pacific Islanders came in second at 36.4 percent, followed by Latinos at 32.6 percent. Among whites, the opioid-related overdose death rate increased by 25.9 percent, and among Native Americans it rose 14.9 percent.

43.4

For every 100,000 residents of West

22 RESILIENT HEALTH | June 2018

Virginia, that’s how many died in 2016 after overdosing on an opioid. It was the highest age-adjusted death rate among the states with reliable data. Other states with high death rates included New Hampshire (35.8 deaths per 100,000 people), Ohio (32.9 deaths per 100,000 people), the District of Columbia (30 deaths per 100,000 people), Maryland (29.7 deaths per 100,000 people) and Massachusetts (also 29.7 deaths per 100,000 people).

4.9

The opioid overdose death rate for Texas. This was the lowest rate among the states in the study.

10.6%

That’s the nationwide increase in deaths caused by prescription opioid medications. In 2015, there were 15,281 such deaths; by 2016, there were 17,087.

100%

The nationwide increase in fatal overdoses linked to synthetic opioids other than methadone. In other words, the death rate associated www.reshealth.net

with these drugs doubled between 2015 and 2016.

200%

That’s how much the death rate due to synthetic opioids increased among Latinos, Asians and Pacific Islanders between 2015 and 2016. In other words, it tripled.

The number of times the CDC report mentions illicitly manufactured fentanyl, or IMF. The researchers said IMF is “highly potent” and is probably fueling the spike in overdose deaths involving synthetic opioids. “IMF is now being mixed into counterfeit opioid and benzodiazepine

pills, heroin, and cocaine, likely contributing to increases in overdose death rates involving other substances,” they wrote.

4.9%

For every 100,000 people living in the United States, that’s how many died of a heroin overdose in 2016. The rate was nearly 20 percent higher in 2016 than it was in 2015.

17.3

The death rate due to heroin overdoses in the District of Columbia. At the other end of the spectrum were Oklahoma and Hawaii, both of which had 1.4 deaths per 100,000 people.

The number of “waves” in the epidemic of opioid overdose deaths, according to the CDC researchers. The first wave began in the 1990s, a result of prescription pain medications. The second wave followed in 2010, marked by fatal overdoses of heroin. The current wave can be traced to the rise of IMF and other synthetic opioids, beginning in 2013. By 2016, these drugs were responsible for 45.9 percent of all opioid-related overdose deaths in the U.S.

Men’s Health Month

nchored by a United States Congressional health education program, Men’s Health Month is celebrated every June across the country with screenings, health fairs, media appearances and other health education and outreavch activities.

The purpose of Men’s Health Month (menshealthmonth.org) is to heighten the awareness of preventable health problems and encourage early detection and treatment of disease among men and boys. This month gives health care providers, public policy makers, the media, and individuals an opportunity to encourage men and boys to seek regular medical advice and early treatment for mental illnesses, disease and injury. The centerpiece of Men’s Health Month is National Men’s Health Week, a special awareness period passed by Congress and signed into law by former President Bill Clinton on May 31, 1994 now recognized internationally. This year, National Men’s Health Week starts on June 12, and ends on Fathers’ Day, June 17. For information about Men’s Health Week activities, health statistics, and contact information for spokespersons and experts on men’s health in your area, contact (202) 543-6461, ext. 101 or write to info@menshealthweek.org.

www.reshealth.net

RESILIENT HEALTH | June 2018 23

The compelling presentation included three case studies of how evidence-based treatments for servicerelated anxiety, substance use and trauma-related disorders were adapted and tailored for delivery via VTH.

Notes from ATA18:

Telehealth Aims to Bring Psychiatric Services Home By Lise Millay Stevens, M.A.

et ready for a world where psychiatric services can be provided right at home. Instead of choosing a pay-perview movie to lift their spirits, patients may soon be able to sit in a beloved armchair–slippers on and kitty in the lap–and receive a therapy session. In a session titled “Increasing the Reach of EvidenceBased Psychotherapy with Videoto-Home Telehealth” at the 2018 American Telemedicine Association Conference & Expo (ATA18) in Chicago, experts explained how connecting with clients at home can enhance treatment, especially for U.S. service people.

The presenters included Julianna Hogan, Ph.D., a licensed psychologist and research health scientist, and Jan A. Lindsay, Ph.D., a licensed psychologist and an investigator from the South Central Mental Illness Research, Education, and Clinical Center (SC MIRECC) at the Michael E. DeBakey VA Medical Center in Houston. Co-presenters Terri Barrera, Ph.D., a clinical psychologist and research investigator at SC MIRECC and medical anthropologist and qualitative methodologist Lindsey Ann Martin, Ph.D., from the Houston Center for Innovations in Quality, Effectiveness & Safety (IQuESt) rounded out the program.

24 RESILIENT HEALTH | June 2018

The goal of the session was to educate attendees on the power of video-to-home technology (VTH) for delivering evidencebased psychotherapy to patients in rural areas and to those who might otherwise avoid receiving treatment. The compelling presentation included three case studies of how evidence-based treatments for service-related anxiety, substance use and trauma-related disorders were adapted and tailored for delivery via VTH. The researchers all reported that using telehealth in psychotherapy increased program access, adherence and retention. www.reshealth.net

By receiving care via VTH, the anxieties of travelling to and sitting in clinics with fellow service people are curtailed. Stepping forward and receiving treatment in one’s home affords the privacy and quiet needed to focus on dealing with difficult symptoms. Considering that the rate of PTSD and anxiety disorders are higher in this population than the general public, VTH could open the door to providing care and recovery to the men and women who serve this country and suffer the psychological consequences.

Dr. Barrera explained that most veterans prefer receiving care at home, especially those suffering from panic disorder who often struggle with agoraphobia—the extreme or irrational fear of entering open or crowded places, of leaving one’s own home, or of being in places from which escape is impeded. She added that in people traumatized by living through hurricane Harvey, for example, telemedicine has been effective in delivering care to those who became afraid to leave home. In patients treated for obsessivecompulsive disorder, eliminating the fear of contamination and constant worry about checking to see if one locked doors upon leaving the home—symptoms endemic to OCD—helps patients to focus on their care without so many intrusive thoughts. Dr. Lindsay explained the role of telehealth delivering care to service men and women with substance use disorders who self-medicate to alleviate symptoms of anxiety www.reshealth.net

The theme of ATA18 was “Learn. Connect. Discover.” More than 6,000 health care professionals from the clinical, academic and tech sectors of the health industry attended, along with more than 100 exhibitors from telehealth tech. Attendees

disorders. Often, she explained, clinicians need to concurrently treat the mental health disorders that tend to accompany addiction, and which too often are not treated at all. The challenge, she explained, is that providers cannot check a patient’s breath for alcohol or perform on-the-spot drug testing to be sure their patients are sober. Therefore, video conference treatment works best at the beginning of treatment to engage reluctant patients but is not as effective for ongoing care.

An attendee at ATA2018 takes a break to admire the beauty of Lake Michigan in spring time.

Overall, the consensus was that, based on previous case studies and the presenters’ own experiences with patients, VTH eliminates barriers to care and improves outcomes, especially for people who have served in the military. The stigma of having mental health and substance use issues is especially prevalent in the toughguy world of the U.S. armed forces, where such issues have long been ignored or swept under the carpet.

learned, innovated, networked and returned to their organizations with actionable insights, long-lasting connections and an enhanced appreciation of tele-health—and how it transforms health care delivery. In addition, the meeting provided actionable insights to help shape the future of one of the most rapidly-growing healthcare sectors; influencing how future patient treatment will be delivered.

RESILIENT HEALTH | June 2018 25

Schizophrenia Test Schizophrenia is a serious mental illness characterized by schizophrenia symptoms, such as experiencing hallucinations or delusions that have no connection to reality (but feel just as real to the person). This schizophrenia test is for anyone who wants to see if they may have the symptoms commonly associated with a schizophrenia-specific disorder, such as schizophrenia or schizophreniform disorder. This test takes most people less than 2 minutes to complete and will provide instant results. Instructions: Have your client answer the questions below based upon how he or she currently feels or has felt in the past month. I am a

year old

Female /

Male /

Other

1. I believe that others control what I think and feel. Not at all Just a little Somewhat Moderately Quite a lot All the time 2. I hear or see things that others do not hear or see. Not at all Just a little Somewhat Moderately Quite a lot All the time 3. I feel it is very difficult for me to express myself in words that others can understand. Not at all Just a little Somewhat Moderately Quite a lot All the time 4. I feel I share absolutely nothing in common with others, including my friends and family. Not at all Just a little Somewhat Moderately Quite a lot All the time

7. I can’t trust what I’m thinking because I don’t know if it’s real or not. Not at all Just a little Somewhat Moderately Quite a lot All the time 8. I have magical powers explain. Not at all Somewhat Quite a lot

that nobody else has or can Just a little Moderately All the time

9. Others are plotting to get me. Not at all Just a little Somewhat Moderately Quite a lot All the time 10. I find it difficult to get a hold of my thoughts. Not at all Just a little Somewhat Moderately Quite a lot All the time

5. I believe in more than one thing about reality and the world around me that nobody else seems to believe in. Not at all Just a little Somewhat Moderately Quite a lot All the time

11. I am treated unfairly because others are jealous of my special abilities. Not at all Just a little Somewhat Moderately Quite a lot All the time

6. Others don’t believe me when I tell them the things I see or hear. Not at all Just a little Somewhat Moderately Quite a lot All the time

12. I talk to another person or other people inside my head that nobody else can hear. Not at all Just a little Somewhat Moderately Quite a lot All the time

| June 2018 26 RESILIENT HEALTH www.reshealth.net To evaluate answers from this test, go to psychcentral.com/quizzes/schizophrenia-test.

At A Glance:

BEHAVIORAL HEALTH IN THE NEWS Compiled by Lise Millay Stevens Abnormalities in Visual Cortex Linked to Mental Illness According to a recent study (https://bit.ly/2I8pSV8) from Duke University, a person’s risk of mental illness broadly increases when the visual cortex has trouble communicating with brain networks responsible for focus and introspection. The researchers used brain imaging and study participant psychiatric assessments to assess the correlation between psychiatric systems and blood flow to key areas of the brain. In people whose scores indicated a higher risk of having a mental illness, the imaging studies revealed reduced efficiency between the brain’s visual areas and certain networks important for integrating sensory information www.reshealth.net

and suppressing distracting information. This reduced efficiency is common in people at risk for certain types of mental disorders.

Incidence of Involuntary Commitment for Addiction Is Growing According to a recent analysis of state data by the Associated Press, law enforcement officials, health care providers and families are increasingly using commitment laws to force people with substance use issues into involuntary treatment (https:// abcn.ws/2GZ6TLi). Approximately 35 states have laws that permit families and providers to petition judges to order individuals into treatment if the person is a threat to themselves or others.

The practice is controversial among many providers and law enforcement officers because treatment often entails painful detox without medications to mitigate withdrawal symptoms and confines patients to prison-like environments. In addition, research has shown that involuntary detox is mostly ineffective and increases the chance of patients overdosing after release from care. Civils rights groups contend that involuntary commitment may also violate U.S. civil rights laws. Nevertheless, states are creating new legislation or acting upon extant statutes to force people with drug addiction into care. Massachusetts, for example, is considering a new law that allows providers emergency powers to remand people with addiction to RESILIENT HEALTH | June 2018 27

detox facilities during evening and weekend hours, when judges are not available. According to the AP’s report, many states do not track whether people with substance use issues who are forced into care are being repeatedly committed or remain sober after being released. Nevertheless, court records show Florida reported 10,000 requests for commitment in 2016 and Massachusetts had a total of 12,000 such requests in 2016 and 2017.

Kaiser Identifies New Method for Assessing Suicide Risk A team from the Mental Health Research Network, led by Kaiser Permanente scientists, has found that combining data from electronic health records with results from standardized depression questionnaires is effective for predicting suicide risk 90 days after either mental health or primary care provider outpatient visits. The study (https://bit. ly/2shkdGE), published in a recent issue of the American Journal of Psychiatry, included seven health systems and nearly 3 million patients age 13 or older with mental health diagnoses. The study subjects made more than 10 million specialty mental health visits and approximately another 10 million primary care visits from 2009 through June 2015. The researchers studied health system records and state death certificate data identified suicide attempts and suicide deaths over 90 days after each mental health or primary care visit.

According to the report, combining a variety of information from the past five years of people’s electronic health records and answers to questionnaires showed that new models predicted suicide risk more accurately than before. The strongest predictors for suicide included prior suicide attempts, mental health and substance use diagnoses, medical diagnoses, psychiatric medications dispensed, inpatient or emergency room care and scores on a standardized depression questionnaire. “We demonstrated that we can use electronic health record data in combination with other tools to accurately identify people at high risk for suicide attempt or suicide death,” said lead author Gregory E. Simon, MD, MPH, a Kaiser Permanente psychiatrist in Washington and a senior investigator at Kaiser Permanente Washington Health Research Institute. The study data showed that suicide attempts and deaths among patients whose visits were in the highest 1 percent of predicted risk were 200 times more common than among those in the bottom half of predicted risk. Patients with mental health specialty visits who had risk scores in the top 5 percent accounted for 43 percent of suicide attempts and 48 percent of suicide deaths.

Los Angeles Suing Six Pharma Companies for Opioid Epidemic According to an article in U.S. News & World Report (https://bit.ly/2shn4zm), Los Angeles is filing a lawsuit that alleges fraudulent and negligent business practices have contributed to an “opioid addiction crisis” in that city. The targets of the suit include pharmaceutical companies Cephalon, Endo Pharmaceuticals, Insys Therapeutics, Janssen Pharmaceuticals, Mallinckrod and Purdue Pharma, and wholesale drug distributors McKesson Corp., Cardinal Health, Inc. and AmerisourceBergen Corporation. According to an article from the Los Angeles Daily News (https:// bit.ly/2IU64tp), the suit contains allegations that the companies in question misled doctors and patients about the appropriate uses, risks, safety and efficacy of pain medications while minimizing the risk of becoming addicted and exaggerating the benefits of their use. In filing the lawsuit, Los Angeles joins more than 60 other U.S. cities who have filed lawsuits against Big Pharma and drug distributors for rising rates of opioid addiction and overdose deaths.

Patients with primary care visits who had scores in the top 5 percent accounted for 48 percent of suicide attempts and 43 percent of suicide deaths.

28 RESILIENT HEALTH | June 2018

www.reshealth.net

FAC I L I T I E S O F S OV E R E I G N H EA LTH

Sovereign Health of San Clemente San Clemente, California Sovereign Health of San Clemente offers high-quality and comprehensive detox, addiction, dual diagnosis and mental health services in residential, partial hospitalization, intensive outpatient and outpatient settings. We also provide specialized treatment including: a holistic detox recovery program, an eating disorders program and a pain recovery program. All of our programs focus on addressing underlying mental health conditions by utilizing innovative and cutting-edge cognitive testing, rehabilitation techniques, and meaurement-based treatment modalities. In addition to thorough assessments, cognitive behavioral therapy, dialectical behavior therapy and individual and group psychotherapy, we offer alternative therapeutic activities such as yoga, equine therapy, art therapy, mindfulness meditation and breathing techniques to help an individual overcome issues and regain control of his or her life.

Treatment Programs Offered: • Detoxification • Nutritionally Assisted Detox • Primary Mental Health

Our Orange County location acts as the flagship for Sovereign Health services by offering both a treatment center and our main offices. This center sits only a few miles from the Pacific Ocean, providing the ideal setting for anyone seeking behavioral health treatment. We have a caring and understanding staff that helps patients feel comfortable and ultimately focus on healing and rebuilding their lives.

• Substance Use

Patients Served

Levels of Care

• Pain Recovery

• Men and Women • 18 Years and Older

• Detoxification • Residential Treatment • Partial Hospitalization • Intensive Outpatient • Outpatient • Recovery Management

For more information, please visit

www.sovcal.com www.reshealth.net

• Dual Diagnosis • Telehealth • Eating Disorders

24/7 ADMISSIONS HELPLINE

888.701.7488

RESILIENT HEALTH | June 2018 29

1211 Puerta Del Sol, Suite 200 San Clemente, CA 92673 (888) 701-7488 www.reshealth.net

30 RESILIENT HEALTH | June 2018