Archive for July, 2011

Solving the real problem

July 31, 2011

When people talk and present their ideas in all formats , formal and informal, tweeting or in front of Congress,  they so often do it without really knowing the depth and breadth of the real problems of their listener . How do you find out what someone’s real problem is? If you can – you may have a shot of being able solve it. But just because you sound brilliant to yourself and even many others doesn’t mean a thing to someone with a problem to solve. There are some skill sets that you really must have in all walks of life. Please check this out if I am speaking to any of your real problems.  It is free to get a taste of some ideas that will stop your premature presentation problem.

NO studies support polypharmacy for young people

July 31, 2011

A quality post from the HeroicAgencies listserve:
“Antidepressants have a black box for children, adolescents, and young adults, warning consumers and prescribers of increased risk of suicidality and clinical worsening, and the need for close monitoring (U. S. Food and Drug Administration, October, 15, 2004). The Hammad, Laughren, & Racoosin (2006) investigation revealed an average risk of suicidality for antidepressant takers double that of those on placebos in clinical trials . Moreover, only 3 out of 15 published and unpublished randomized controlled trials of SSRIs showed them to be more effective than placebo on primary outcome measures, and this is with all the design flaws that Barry and I have written about many times (yes, there is a chapter in Heart & Soul of Change, Revised Edition on this), including lack of adequate blinding, reliance on clinician-rated measures, short time frames, conflicts of interest, and minimization of risks. No patient rated measures ever showed a difference between the SSRI and placebo in any of the trials.

In the case of Zoloft (Sertraline), that drug is not approved for children or teens (except for OCD). There were two trials conducted by Wagner in 2003 of this drug. Individually, the results did not show a difference between Zoloft and placebo. When pooled, there was a difference in favor of Zoloft on the primary outcome measure. Interestingly, in these trials, participants could be discontinued at the discretion of the investigator for failing to improve, despite increased doses. This is curious, to my mind. Also, 17 Zoloft takers left the study due to adverse events compared with 5 in the placebo group. Of the 7 serious adverse events, there were 5 for suicidality and 1, aggression, in the Zoloft group compared with 2 for suicidality in the placebo group. True to form, the authors conclude that sertraline was well tolerated.

Seroquel is an antipsychotic, approved for mania or psychosis in this age group. This is a powerful and dangerous drug. Side effects include those typical for this class of drugs–somnolence, involuntary movement, cognitive impairment, elevated prolactin, intracardiac conduction, neuroleptic malignant syndrome, polycystic ovarian syndrome, weight gain and general metabolic disorders. Trazadone is an antidepressant and is not approved for under 18. Side effects include drowsiness, extrapyramidal symptoms, fatigue, liver problems, and more.

It is important to note that there are NO studies supporting polypharmacy for young people. This is all “throw the plate of spaghetti and see what sticks.” It is not hard to see that the pharmaceutical industry is very happy to have kids on as many drugs as possible–we’re talking double, triple, quadruple the profits. This trend is backed by recent studies. Psychiatric polypharmacy is both prevalent and increasing in pediatric populations, in tandem with more diagnoses. Although little is known about the safety and efficacy of regimens that involve concomitant use of two or more psychotropic drugs for children and adolescents, multiclass prescription for those under 18 is increasingly common.

So, this young person is playing with fire. I think that it is reasonable to share concerns with the adolescent, the parents/caretakers, and the psychiatrist and to make sure that the adolescent and family know about these risks and can make an informed decision about what they want to do. If she, and parents, want to decrease or eliminate medications, this could then be discussed with the psychiatrist who can reduce the meds to zero. Importantly, there are non-drug options, including psychotherapy, vocational support, sleep remediation, exercise, and others that can be beneficial, depending on the young person’s circumstances and preferences. ”

Jackie

Jacqueline Sparks, Ph.D.
Associate Professor
Department of Human Development and Family Studies
University of Rhode Island
2 Lower College Rd.
Kingston, RI 02881

The Toughest Negotiation

July 31, 2011

 

The toughest negotation is the one you will have with yourself. Speaking for myself, I find that when I tell myself I that I may do something or that I should do something, I am usually playing some sort of game with myself.  Even when I say I will do something, if I don’t actually take action immediately, it really amounts to me not doing it. When I decide not to do something, however, I give myself a chance. Why?? Well, I am no longer playing  a game and all the  problems that are keeping me from doing something will start to arise in my mind. Those justifications may be valid, they may not be, but I can count on them to come to the forefront of my mind as I sit on my  ’no’. This allows me to deal with the problems/’justifications for no’ if I can. When I do, I  get to a more solid standing from which to take action. I avoid putting the cart before the horse.

A ‘no’ may last only 5 minutes, but a bullshit ‘yes’ to action or worse, a ‘maybe’, will often take a lot longer. Even if it doesn’t, I am probably distracted while taking action by not having looked at the problems that the ‘no’ would have allowed me the time to.

Start With No

The intelligent use of ‘no’ with kids ( and anyone)

July 15, 2011

From a yahoo article:

We’re too negative.

“Don’t hit your sister!” “Stop pulling the dog’s tail!” The number of things you tell your toddler or preschooler not to do is endless.

THE FIX Ask for the behavior you want to see. Nobody wants to raise a child who doesn’t understand limits, but “parents say ‘no’ so frequently that kids become deaf to it — and the word loses its power,” Dr. Borba explains. Moreover, “we often tell kids not to do something without letting them know what they should be doing,” notes Linda Sonna, Ph.D., author of The Everything Toddler Book. So save the naysaying for truly dangerous situations (think: fork in the electrical socket or your child eating the spider plant), and focus on telling kids how you would like them to behave. For example, instead of, “No standing in the bathtub!” try, “We sit down in the bathtub because it’s slippery.” Later, when you notice your kid splashing away in a seated position, offer some praise (“I like how you’re sitting!”) to reinforce her good behavior.

my thoughts: I think we have been conditioned to see ‘no’ as negative, but is it negative? What is ‘no’ really? It is a decision that has been made. Once we say ‘no’ though,  we need to  work to build vision in our kids about how they can solve their problems and get what they want. This article decribes that nicely, though I don’t agree that we should only use no in life threatening situations. We want our kids , and anyone from whom we are wanting a decision, to feel comfortable saying no and hearing it.

Demise of antidepressants… What does this mean for therapists?

July 13, 2011

Some damning evidence about the efficacy of anti-depressants is surfacing. It made it to the NY Times and a defense of anti-depressants by famous author Peter Kramer was pretty soundly rebutted in a Psychology Today article.

http://www.psychologytoday.com/blog/mad-in-america/201107/the-new-york-times-defense-antidepressants-0

I think psychiatry will start moving toward stronger drugs…they already do now when SSRI’s aren’t working. The hope that psychiatry promises continues to bring people into their office, and that hope ( call it placebo if you want) is hard to discard. Psychiatrists also refer people to therapy when meds aren’t helping, so this ‘hope’ at least gets the ball rolling. Psychiatrists end up acting as a sort of triage service for therapists , and folks willing and able to make the effort that therapy requires get a shot they may not have had otherwise. But maybe I am just rationalizing here out of a fear of uncertainty that a world without meds would be like …fewer referrals for me. I’d have to develop a real plan to reach out and find customers. That would take money and effort -and maybe this idealized world of meds we still live in has just made me lazy.  Not right. Change must involve more legwork by all of us – more human contact!

Getting an interview and a job

July 12, 2011

 

If you are, you are more likely to get one if you know how to negotiate. You have to be able to negotiate with the receptionist to even have a shot. Otherwise, your application sits  there among hundreds. Nothing replaces being able to get to the right person to talk to, and knowing how to talk to them with confidence and emotional control.

Check out what you can do about this:

Start With No

Feel free to email me

wchase5@yahoo.com

or call me  (401) 996-6198. If I don’t pick up and you leave a message, I will call you back.

Thanks,

Wim

Size doesn’t matter.

July 6, 2011

There is no greater or lesser being, only being…..no exceptions

How Everyday Davids Win 1/3 of the Time—and Strategies For Slaying Your Personal Goliath –  http://t.co/h3VYAM6

 

Fireworks and Feelings

July 5, 2011

Last night,  fireworks kept waking up the girls ( 3 & 4)

Clara Rose said, “the fireworks are hurting my feelings”.


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