Understanding Psychosis

By  Sara Coffey, D.O.



Often patients and family members have a hard time understanding how a person can be psychotic.  Psychosis is defined as grossly impaired reality testing. Psychosis can be present in several mental illnesses including, schizophrenia, schizoaffective disorder, bipolar disorder and even depression.

The stigma or lack of information surrounding these disorders leaves them feeling guilty or ashamed. I often explain to them that the brain is an organ just like the heart, the kidneys or the liver. And just as our heart, kidneys or liver can become diseased, so can our brain.

The brain is a complicated organ with several different functions. It helps regulate our breathing, our heart rate, and our temperature and handles more complex tasks such as vision and hearing, pain sensations as well as processing complex thoughts or emotions. It is easy for us to understand that if the heart becomes damaged it might not pump as effectively, but it is often harder for us to understand what happens if the brain becomes compromised or unwell. A brain with mental illness may start to hear things that are not there, or experience thoughts that cannot be explained and seem irrational.  A person may become excessively anxious for no reason, or depressed without warning or cause.

In the world of mental illness we use terms to describe such experiences like hallucinations and delusions.  A patient with hallucinations might experience voices talking to them when no one is present. When we recall that one function of the brain is to process and interpret sound it is easy to see how auditory hallucinations might occur if that part of the brain is compromised.

Patients can have delusions that people are out to harm them for no reason, and without proof, or delusions that they are famous powerful figures in history. And again, when we look at how the mind works, how complex processes are taking place that help us navigate who we are and what we do, it makes sense that if something wasn’t working normally in the brain that a person could have a belief that was false.

Although these symptoms might make sense when we look at the brain as an organ, or a tool performing a function, it doesn’t lessen the impact mental illness has on families. Often mental illness takes away what we consider the heart or personality of person and this can be extremely difficult to cope with. Furthermore, the simplicity of understanding is not without criticism. For instance although we are learning more and more about the brain every day, there is still no cure for mental illness, only treatment for symptoms, and often times the treatment cannot fully clear the symptoms of certain diseases.

However, it is important to know that psychosis, like other mental illness symptoms, is not the fault of the person with the illness or the family who cares for them. These symptoms are part of a complex illness that affects patients unwillingly every day.

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Raising Awareness About Stuttering and Speech Disorders

By Adair Parr, M.D.



The Oscar nominations were recently announced and one particular movie in the best picture category is a film which addresses a common problem: stuttering. The King’s Speech depicts the courageous efforts of King George VI of Britain, played by actor Colin Firth, to overcome a stutter which first began when he was a young boy. Although many films have featured characters who stutter, this is the first film to focus on the process of someone overcoming speech difficulties.



The King’s Speech highlights the speech therapy that the king went through to overcome his stutter. The movie aptly demonstrates his frustration with prior attempts at speech therapy. His work with Australian speech therapist Lionel Logue, portrayed by actor Geoffrey Rush in the film, allowed him to move beyond the previous failures that he had in speech therapy and to achieve success. The story is particularly inspiring as you watch this man deliver a powerful speech to the British people on the brink of World War II. Hopefully, the movie will result in less stigma about stuttering.



Here is a video of His Majesty King George delivering his actual speech on Sept. 3rd, 1939.

Stuttering is a type of speech disorder which affects the fluency of speech. Stuttering is a fairly common phenomenon. Approximately 1 percent of children stutter, and up to 5 percent may display transient stuttering. Stuttering begins during childhood, typically between ages 2 and 4 and may last throughout life. It may involve repetitions of words, prolongation of speech sounds and blocked sound.

What should you do if your child has a stutter or other speech disorder? It is recommended that you seek an evaluation from a certified speech-language pathologist. Your pediatrician, physician or school system may help you find local resources. More information on stuttering is available at the American Speech-Language Hearing Association website.

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...towards a m a n i f e s t o

Some thoughts on happiness...

Hedonic well-being?

Let Sunshine Win the Day
or Cynicism: it’s healthy and it makes me happy

The North West m a n i f e s t o events came about as a response to societal changes and as a way of artists and health allies expressing their frustrations and articulating shared passion. As a piece of work, it’s less about strategising and more about connecting and moving forward, and very much in the tradition of artist’s manifestos: its about shouting from the roof-tops.

Last week’s event in Liverpool was planned to give voice to practitioners across Merseyside to come together and exchange ideas and vision to inform the manifesto and celebrate some of the unfolding activity across the area. So, as part of a series of events, exploring shared aspirations for the field, this was a bit of a hybrid event, and with over fifty people in the room was vocal, buoyant and inspiring.

I introduced the session by framing our practice in relation to wider national and regional activity and placing the arts at the heart of society, both in reflection and reaction.

Artistic Director of FACT, Mike Stubbs went on to give a Liverpool context, painting a picture of a thriving and engaged cultural sector and challenging us to think about how we evidence our impact.

Punctuated with artist’s interventions, the session drew some significant thoughts and insight from participants that can be found on the dedicated m a n i f e s t o /merseyside blog pages (only available to that sessions participants, but all the m a n i f e s t o sessions will be drawn together leading up to June 2011).

The only off-note, was in Nic Marks’ rounding-up of the morning. Marks, of the new economics foundation (nef), mistakenly forgot he was at an arts event and not a happiness forum, missing, as he did the cynicism, experience and discontent in the room, (and perhaps wider society).

Whilst many of the people in the session had eloquently described how the arts are, by their very nature political, and I’d opened the session by expressing frustration at societal acceptance of blame for government mismanagement and the crimes of the bankers, Marks focused on what he saw as ‘cheap shots’ at the happiness agenda.1

Now I may be mistaken, but at all the m a n i f e s t o events, I’m mindful of ensuring a couple of things; keeping what I say as consistent as possible, for parity’s sake across the region, and focusing on the long (and rather obvious) history of the arts being more than little baubles and trinkets to pacify people, but as exciting, provocative, subversive and again, political.

By suggesting that cynical politicians may just be hijacking the happiness agenda and arguing our work wasn’t just about making people happy, I apparently blinded Marks to why he was there: to look at the arts in relation to well-being.

And the Five Ways to Well-being by nef are pretty much accepted as good, common-sense ways of looking at day-to-day actions to promote well-being. By connecting with people: being active: taking notice of things beyond our day to day: keeping learning and giving. So no argument there, in fact this ‘latest scientific evidence’ is blindingly obvious.

That’s why we asked Marks to round things off; we thought that all these actions might in fact, contribute towards more fully engaged members of society who connect with others and actively debate and question the status quo: take more than a passing interest in the sound-bites of the popular press and see the potential of shared voices and practice as being part of something bigger: contributing to wider civic society.

Surely then, the result of being a fully engaged citizen might just lead to a more cynical and less superficially ‘happy’ society. Describing my comment about our work not just being about making people happy, as being a ‘cheap-shot’ typical of the media, and for a ‘quick laugh’ Marks risked skewing the whole flavour of the session and devaluing the contributions made.2

I doubt that anyone taking part in the session would question the impact of the arts on well-being, that’s why we’re all involved, we weren’t there to explore the damage we can inflict on each other with our practice.

The point is, that the arts offer so much more than hedonic gratification, and through participation give voice to frustration, anger and cynicism; in other words, art is more than the blind pursuit of happiness (whatever that is) that we’re all told we must aspire to.

Like flat-screen TVs, 4x4 cars or celebrity spray-on tan, it seems happiness is being peddled on the consumerist must-have shopping list. Well, with 2.5 million people unemployed and counting, it looks like the only quick-fire state route to happiness will be through prescription drugs, no doubt on offer through our local National Health Franchise.

Whilst we’re on our way to understanding well-being, (and I’d suggest that the arts and cultural engagement play a big part in that journey), I find it increasingly difficult to imagine how subjective happiness can be identified let alone measured.

And yet as far back as the 2006 Conservative Party Conference, David Cameron has muted the idea of a happiness index, commenting, ‘Let optimism beat pessimism, let sunshine win the day..." Five years later, the NHS, Education and Cultural sectors are undergoing fundamental changes and the banking crisis has thrown the global economy into turmoil. Under the instruction of Cameron, a happiness index is being prepared as I type.

Clive Parkinson
Blue Monday: January 24th 2011

1. In his summing up, Marks said that Cameron and the Government don’t talk about happiness, whereas in reality, there is a wealth of coalition rhetoric on the subject.
2. Rounding off the event and from the lectern, Nic Marks looked me squarely in the eyes and asked, ‘Isn’t happiness the most important thing for our children?’ (Like Ricky Gervais, but without the irony). I wanted to scream, ‘Of course it is, you twerp!’ but I applauded politely thinking, ‘I’d like my children to have a healthy degree of cynicism too; oh and food and shelter, oh and education and love...’

When Divorce Happens

By Gariane Gunter, M.D. 



A recent study was published in Health Day that discusses the mental health of children of divorced parents. While I am not in the position to support or deny the findings, the topic of divorce when children are involved is often a difficult one. Every family is different, but the following are some general tips for divorcing parents that can be helpful.



1. Attempt to keep a positive attitude during the point of separation. This is often a very trying time for the family. Stick to a routine and embrace the activities your children have always enjoyed.

2. Don’t forget to nurture yourself. Going for a walk, having coffee with a friend, or reading a good book are ways to rest and regain energy. It’s normal to feel exhausted when separating; and possibly for many months to follow.

3. Encourage kids to openly discuss their feelings, positive or negative, about what's happening.

It's important for divorcing, as well as already divorced parents, to sit down with their kids and encourage them to say what they're thinking and feeling. But you'll need to keep this separate from your own feelings. Most often, children experience a sense of loss of family and may blame you, the other parent, or both of you for what is going on in their lives. You really need to be prepared to answer questions your kids might raise. They might feel guilty and imagine that they "caused" the problem. Kids and teenagers may feel angry or frightened, or worried about their future. Counselors can assist with this difficult conversation and provide a safe environment if safety is a concern.

4. Although very tempting, try not to speak negatively about your former spouse when your children are present. This issue, often called “parental alienation” can be a problem. Doing things such as putting your child in the middle, saying negative things about the other parent, and using your child as a messenger puts your child in a “no win” situation and creates lifelong relationship issues for all involved. The reasons include the following:



• The comments may confuse and frighten children.

• Many of your concerns about your former spouse are difficult for you to express. It is very important that you keep these concerns to yourself. Children just do not have the emotional maturity to withstand information/situations that adults find stressful.

• Your child’s identity and self concept is based on parental behavior. Even if it is next to impossible to say anything good about your former spouse, try to do so. If this is impossible then don’t say anything.

• Children love to eavesdrop. Telephone conversations are their favorite snooping ground. Make all effort to not discuss your divorce-related difficulties on the telephone when your children are around.

5. During the crisis point of separation try to remember that your children need you both parents more than ever. This is not a time to deny access unless a professional deems it necessary to do so for safety related reasons.

6. It is important to accept the fact that a separation involves feelings of loss for children. Try not to panic if the following behaviors occur during the first few months of separation:

• Sleep difficulties like disrupted sleep, an inability to sleep, exhaustion etc.

• Social isolation

• Anger, intolerance, grumpiness

• Avoidance of divorce related conversations

• Obsessing about the divorce

• Appetite changes

• Feelings of worthlessness

• Tears and feelings of overwhelming sadness

7. Although many children do not ask to see a counselor when their parents separate, they usually find counseling very helpful.

8. It is important to acknowledge that children are very loyal and protective of their parents. If children are placed in loyalty binds they can experience anxiety. Try to alleviate their anxiety if they decided to “pick a side.” This is a coping skill which teens in particular use. If your child engages in “picking a side” try not to feel rejected.



9. Think of yourself as a survivor not a victim. And be patient. Everyone takes different times to heal.

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The Truth About Domestic Violence

By Roberto Blanco, M.D.



In my work with patients across the world, I can´t help but notice how many come to psychiatric clinics as a result of domestic violence. Despite its prevalence in other countries, domestic violence is also quite common in the United States. In the United States alone, 22 percent of women are physically assaulted by an intimate partner during their lifetimes and over 5 million are victims every year. Domestic violence touches all elements of society regardless of age, race, or socioeconomic status.

As a child psychiatrist, I can´t help but think of the smallest victims of domestic violence as I often see them in my clinical work. These are the children who are either involved secondarily by witnessing the abuse or become victims directly themselves. The effects of domestic violence on this population are far ranging and long lasting. As these children develop, they may struggle to deal with conflict. They may also become aggressive or experience severe depression, nightmares and other symptoms of post-traumatic stress, as well as other anxieties or fears.



The effects of domestic violence on children are dependent on the nature and severity of the abuse and on the developmental level of the child. Young babies and infants cannot understand why violence occurs in the home and so violence in this population can cause deep-seated changes in personality, self-esteem, and ways of interacting with others that can last for a lifetime. Often older children have a better understanding of what is going on, but still often blame themselves for the abuse and can have excessive guilt or anger as a result.



Domestic violence does not need to be only physical to qualify as a form of abuse. Abuse can also take the form of emotional, financial, or sexual control or disregard. Initially, characteristics of an abusive relationship can often be endearing such as wanting to be with you all of the time. Over time, this can become intense jealousy for no reason, excessive control over relationships and behaviors, and aggression or violence. Options for milder forms of emotional abuse can include family and/or individual therapy. For severe cases, there may be a need to get out of the situation or to a safe house. For more information on domestic violence, please see the American Pyschiatric Association's brochure  Let´s Talk Facts About Domestic Violence.

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Lessons Learned in the Wake of Tragedy

By Gina Newsome Duncan, M.D.





Dr. Molly McVoy recently blogged about the horrific shootings of Representative Gabrielle Giffords and others on Saturday, January 8, 2011. This tragic incident has sparked widespread national debate about all aspects of the case, including mental health treatment in this country and links between violence and mental illness.



The fact is that most people with mental illness are not violent, and that violence is most often caused by those who are not mentally ill. However, this incident does provide an opportunity for us as a nation, to seriously consider the state of our mental health services. If we examine it carefully, we can possibly prevent further acts of violence, and also think about how we help those who are in need of mental health treatment.



It is an unfortunate reality that mental illness remains largely shrouded in stigma, and tragic events such as this often help to only deepen that stigma in the minds of the public. As a result of this stigma, many people live with unnecessary shame and suffering, not seeking the help that they need. Most often, the primary victim is the person living with the illness, and by extension, their loved ones. Very rarely, however, untreated illness can lead to tragic consequences that reach far beyond the person with the illness and his or her family.



Like physical illness, mental illness has the best outcome when recognized and treated early. We should let this tragedy be a call to become more proactive in addressing issues of mental illness in our communities.

There are several important steps that can be taken:



1) As a public, we can become more informed about the signs, symptoms and treatment of mental illness.



2) We can all work to  destigmatize mental illness. The American Psychiatric Association’s Council on Communications is actively involved using this blog and with other activities.



3) Educate yourself on how mental health is funded in your community and let your vote count when issues of mental health funding are on the ballot.





It is true that there are rare situations in which a person with a severe mental illness may become violent. In most cases, this violence will be self-directed in the form of suicidal acts, but in rare instances, it may be directed toward others as well. What can be done in those situations?



1) If you are personally experiencing a mental illness and are having thoughts of harming yourself or others, it is important that you seek help from a doctor, therapist, or 911 immediately.



2) If you are the friend or family member of a person experiencing a severe mental illness and you are concerned due to actions or statements they have made that they may be a danger to themselves or others, it is important that you seek help from a doctor, therapist, or by calling 911 immediately.



a. Be as detailed about your concerns as possible.



b. Do not let your concern go unheard, put it in writing.



c. Firearms and weapons should be kept sealed and locked, or ideally, removed from the home.



d. Unfortunately, many communities do not have adequate crisis prevention resources. Familiarize yourself with the procedures your community does have for involuntary hospitalization. You can get this information by calling your local health department, hospital department of psychiatry, emergency room, community mental health center, family physician, or police department.

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Bits and Bats…an Arts and Health Networking Miscellany
27th January, 6:00 – 8:00
Venue at MMU: Details will be emailed to you at least 48 hours in advance

Just to remind you that at this networking evening, I’ll be sharing some very quirky films from the early days of the NHS, purely for our fun and conversation. They are wonderful. If you have any film/new media at all that you’d like to share, please let me know in advance.

m a n i f e s t o update…
For those of you who have been involved in these events to date, a big THANK YOU. There’s another event at the Bluecoat Gallery on the 19th.

Its part m a n i f e s t o and part celebration of work underway in Merseyside and if you want to attend, please get in touch with Polly Moseley at pollymoseley@mac.com  

Following the first stage m a n i f e s t o work which has seen a gathering of passion, vision and aspiration of those involved, I’ll be drawing all the strands together for a second stage of activity which will see us coming together and refining what it is, where it goes and what we do with it. By June 2011 we’ll have something very public to share.

The North West Arts and Health Network is past 1500 members…but what does it all mean?

In reality, our reach is potentially far wider than this, as a number of you email this to your networks on my behalf (thank you)!

Remembering that this network is informal and free…what is it that you’d like to see happening? How can we support each other and what would be useful to have online…most anything is possible.

It would be easy for me to put a survey out and ask you all the obvious questions; but what would the point be? Because if I’m asking the questions, I’m steering things just a bit too much.

So what might be a good starting point is if you email me thoughts, ideas and aspirations and I’ll put some of those questions on the BLOG, anonymously, but so others can see the sorts of things people are talking about. So feel free to email me at artsforhealth@mmu.ac.uk and we can beef up our network in ways that are useful to you.


News in from Jeremy Hunt...

… ‘Culture and sport support a range of policy priorities including, but not limited to, economic growth, health and wellbeing, and safer and stronger communities’.

Thanks for that one Jeremy.

See his letter to local authorities below.

29 December 2010

Dear Councillor

We are writing to you about our shared goal of getting better local services for people and to update you on some practical measures to help local authorities delivering cultural and sporting services when the government's overriding priority is deficit reduction, as reflected in the local government finance settlement.

We would like to highlight some of the many examples of improvement and modernisation across local cultural and sporting services. Culture and sport support a range of policy priorities including, but not limited to, economic growth, health and wellbeing, and safer and stronger communities. It is for these reasons that culture and sport are so important to communities and tend to attract significant local interest. Councils across the country have also learned that it is important to prepare for changes with evidence that can be defended.

Through the Future Libraries Programme (FLP) the Local Government Group and Museums, Libraries & Archives Council (MLA) are supporting 36 councils to find new ways to deliver library services without cutting the front line. We thought it would be helpful, ahead of the formal publication of findings from the programme, to share with you examples of the leading savings options that are emerging and our newsletter gives you more information. The MLA and Local Government Group can help if you want to find out more and are available to assist you in looking at a wider range of options and ideas for your library services that could help you save money while minimising the need for cuts to front line services.

Library authorities outside the programme are also developing innovative approaches to providing services:

* Essex County Council will be helping to improve Slough Borough Council's library service and reduce its administration costs from 1 January 2011;
* Investment by Aviva has contributed towards the transformation of York Central Library with more books, the latest technologies and new services;
* In North Yorkshire volunteers at Grassington Hub are at the heart of service delivery.

We are convinced that innovation, led by the energy and experience of councils themselves, is also going to provide the best recipes for modernising cultural services generally in a tougher financial climate.

There are also lots of examples of councils developing different approaches to providing local cultural and sporting services and responding to the economic situation by being innovative:

Many councils are successfully commissioning their cultural services to deliver more efficiently other key service priorities such as adult social care, health, better outcomes for children and young people and economic development;

* Manchester City Council has focused its culture and sport services as major drivers of economic growth, inward investment, and job creation and training;
* Leicester Comedy Festival has developed relationships with communities and the health service to respond to issues such as men's health, teenage pregnancy and healthy eating amongst children and young people;
* Suffolk Artlink manages a series of projects aimed at improving the lives of vulnerable people in Suffolk including older people and their carers;
* In Kirklees a partnership between creative arts organisations offer a range of services for people as part of their mental health and wellbeing care planning services.

There are a number of different ways by which examples such as these are shared widely across the local government sector, including:

LGID's website brings together in one place the learning that is coming out of the "Passion for Excellence" improvement work in partnership with DCMS and key public bodies.

http://www.idea.gov.uk/idk/core/page.do?pageId=21131849

The Living Places website is a suite of online resources developed by DCMS and key public bodies to support the contribution of culture and sport to planning http://living places.org.uk  

LGID has also launched two new publications outlining ways the sector can improve its efficiency through new ways of working and making better use of assets and sources of further help. http://www.idea.gov.uk/idk/core/page.do?pageId=24327034  

Help and advice is available and it could assist you in providing the culture and sport local people will be looking for while making the savings that are needed.

JEREMY HUNT
Secretary of State for Culture, Olympics, Media and Sport

Cllr CHRIS WHITE
Chair, LG Group Culture, Tourism

Shootings Stir Emotions, Call for Access to Affordable Care

By Molly McVoy, M.D.



The tragic shooting in Arizona has spurred many emotional headlines and provocative stories in the news. News stories have used the words “insane,” “coldblooded,” “bizarre,” “evil” and “troubled.”



Whenever tragedies such as this occur, emotions are stirred and people often look for clear answers. Unfortunately, tragedies like this do not have easy answers. Whether or not mental illness is involved in this case, this may be a moment to look at every way to reduce the risk of another tragedy such as this in the future.



Rep. Giffords



U.S. Rep. Gabrielle Giffords, currently in an Arizona hospital as a result of the shooting, is a friend to the National Alliance for Mental Illness (NAMI) and has served as co-chair of several fundraisers for NAMI in Southeast Arizona.



There are so many ways in which the mental health system in the United States is broken. Treatment is often hard to access and expensive. Consistent treatment is often nearly impossible for those with severe mental illness. Advocating for improved access to quality mental health care is critically important at a time like this.



In addition, it is also important to remember that the likelihood of violence from those who struggle with mental illness is very low. Most of the violence perpetrated in this country is by individuals without mental illness. Most individuals suffering from mental illness are not violent.



No matter the cause, a time like this calls for reflection and action: examining all the factors that can be changed to minimize the risk of something like this happening in the future.

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Six Tips for Talking to your Doctor about Medication

By Claudia L. Reardon, M.D.



In my last blog, I addressed the factors psychiatrists consider in choosing a given psychiatric medication for a patient. I emphasized the importance of medication selection being a collaborative process between the physician and the patient. In the midst of an appointment with a psychiatrist, though, it can be difficult for a patient to know what to ask, and when and how to ask it. This article includes tips for patients to help them work with their physicians in finding the best medications.

1. Ask the psychiatrist, “How did you pick that medicine?” Even if you can think of nothing else to ask during an appointment, this single question will probably lead to a wealth of useful information. For example, it might lead to a discussion of the target symptoms, how the medication affects other medications or medical conditions, and side effects.


2. Make a list of medication questions to ask your psychiatrist at your next appointment. I find it extremely useful when my patients come in with a list of questions they have made since I last saw them in my office. This way, patients are sure not to forget to ask anything important to them.


3. Take notes during your appointments. It can be difficult to remember everything your psychiatrist says during your appointment, and so bringing a note pad and pen along to take notes can be useful so that later you can remember what was discussed.


4. Read books. There are a number of excellent books available for patients on psychiatric medications. In my experience, patients find especially useful the book Instant Psychopharmacology by Ronald Diamond, M.D.


5. Visit websites. Patients should be careful about which websites they visit, as not all are reliable sources of medication information. However, in addition to www.HealthyMinds.org, another reputable site is the NAMI medication website. Go to the NAMI webpage (www.nami.org) and click on the “Medications” tab on the top toolbar.


6. Try not to be embarrassed. Many patients are embarrassed to talk about concerns they have about medications, especially side effects that they find difficult to discuss. However, remember that physicians hear about all kinds of different side effects, and it is pretty hard to embarrass a physician when it comes to talk about the human body!

In addition to these strategies, you might have found others that work for you in keeping you engaged in your medication treatment. It is imperative to keep the lines of communication open with your psychiatrist and to remember that your physician is there to answer any questions you have.

Which Medicines and When: Collaborative Process of Finding the Right Medicines

By Claudia L. Reardon, M.D.

Many patients have long and trying journeys on the way to finding medication regimens that work for their psychiatric symptoms. It isn’t always obvious why psychiatrists choose certain medications and avoid others for given patients. In this blog post, I will review the process by which a physician chooses a psychiatric medication. The more the patient knows about how the psychiatrist is thinking through the medication decision-making, the more active a role that patient can play in the process. 

Psychiatrists consider the following issues when prescribing a medication:

1. Target symptoms. A patient might have many different symptoms, for example, depressed mood, anxiety, trouble with concentration, and severe insomnia. It is important to decide which symptoms should be addressed first, since it is likely that one single medicine will not help all of the symptoms. Doctors often prefer not to start multiple medications at the same time, as it otherwise can be difficult to figure out which medicine is helping or which is causing side effects. Thus, in a patient with the above symptoms, the physician might first choose to address the patient’s depressed mood with an antidepressant. Since trouble with concentration and severe insomnia could be caused by depression, it is possible that treatment with an antidepressant will help those symptoms as well. It is important to address the symptoms in the order that makes the most sense.


2. Psychiatric diagnosis. The physician cannot simply treat a target symptom with a medication without knowing the overall psychiatric diagnosis. For example, depressed mood could be due to many different diagnoses, including major depressive disorder, bipolar disorder, schizoaffective disorder, drug or alcohol abuse, or medical problems such as low thyroid. All of these would have different treatments. Major depressive disorder would be treated with antidepressants, while antidepressants can actually sometimes worsen bipolar disorder. Likewise, if a patient’s depression is caused by a medical problem, it is essential that the medical problem be addressed rather than simply “band-aiding” the symptom of depression with an antidepressant.


3. Medical conditions and other medications. It is critical that the physician be aware of all the patients’ medical issues and other medications they are taking. Certain psychiatric medications would be dangerous if prescribed to patients with certain medical problems. For example, some medications can worsen seizure disorders, cause abnormal heart rhythms, or worsen diabetes. Additionally, some psychiatric medications can have dangerous interactions with other medications.


4. Side effects. Psychiatrists must consider how a given medication’s side effects will impact a given patient. For example, a patient who drives heavy machinery for a living should probably not take a medication that causes drowsiness. On the other hand, sometimes physicians can “take advantage” of side effects. For example, if a patient is sleeping and eating poorly, the doctor might prescribe a medication with sleepiness and increased appetite as side effects.


5. History of response. If a patient or his or her family member has had a good response to a medication in the past, that might be a good reason to choose that medicine now.


6. Patient preferences. Finally, and most importantly, the physician must make sure that the patient is willing and able to take the medication being prescribed. If the patient feels that the side effects are intolerable, or simply cannot afford it, it doesn’t matter how reasonable the choice of medication might be since the patient will not take it. The physician should check with patient to ensure they are comfortable with the medication being prescribed. Likewise, patients should not hesitate to speak up if they have concerns about a medication being prescribed for them.

In summary, physicians consider a multitude of factors in choosing a psychiatric medication for a patient. Ultimately, the decision about a medication should be a collaborative one between the psychiatrist and the patient.

Annus horribilis?

Mark Wallinger

A Plea for Pessimism...

Last November I had the pleasure of speaking at the 2nd Annual International Arts and Health Conference in Melbourne. My paper; A Brightly Coloured Bell-Jar explored the relationship between our aspiration to well-being and increased dependency on medication for all our ills. You can hear a podcast of this paper at http://www.artsforhealth.org/podcasts and it will be available in print in February 2011.

Polly Morgan

Two pieces of writing that echo and expand on some of the themes I raised are below.

Is this the end of the children’s decade?

Polly Toynbee questions whether voters believe David Cameron's new year's message, that: "We're tackling the deficit because we have to – not out of some ideological zeal. This is a government led by people with a practical desire to sort out this country's problems, not by ideology. When we talk of building a bigger, stronger society, we mean it." Or will they believe Ed Miliband's view that the "irresponsible pace and scale" of the cuts is a "political choice by those in power, not necessity"?

http://www.guardian.co.uk/commentisfree/2010/dec/31/end-childrens-decade-coalition 

Steve Bell; The Guardian

How to Stop Living and Start Worrying.

Since when did happiness, wisdom and contentment become the cornerstones of a fulfilling life? Whatever happened to doubt? Instability? Melancholia? 

This month, Polity Press are releasing How to Stop Living and Start Worrying, a collection of interviews with Simon Critchley, which playfully parodies the conventional self-help manual. Critchley sketches an alternative view of the role philosophy plays in our lives today, covering an ambitious range of topics: from science and religion, to poetry and politics, love and humour, life and death.

http://www.apieceofmonologue.com/2010/09/critchley-stop-living-start-worrying.html

…and finally

The next  M A N I F E S T O  event will be on the 19^th January at the Bluecoat Gallery in Liverpool…details to follow.

...and don’t forget the first North West Arts and Health Networking session of the year on January 27^th between 6:00 and 8:00 in the evening when I’ll be sharing some odd little films from the birth of the NHS in the 1940’s and I encourage you to submit material for sharing too. I’ll confirm the venue the week before, but for now, could you RSVP to artsforhealth@mmu.ac.uk