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Several people have asked whether the Safe Harbor conference in June on "Non-Pharmaceutical Approaches to Mental Disorders," which provides 15 hours of Continuing Medical Education for physicians, also provides continuing education hours or "contact hours" for nurses and others in the healing professions.

We have been informed by the California Board of Registered Nursing that the answer is YES for California nurses.

The California Psychology Board has also affirmed the hours are valid for continuing education credits for psychologists.

These boards accept Category 1 credits from the American Medical Association, which is what we are offering. Many boards for healing professions, such as chiropractors and nurses, accept Category 1 credits. If you have any questions, please contact us. Nurses from other states should check with their respective boards.

For full information on the conference, please visit AlternativeMentalHealth.com.

Four authors will take part in a book signing at the Safe Harbor conference of June 15-16, 2002, entitled "Non-Pharmaceutical Approaches to Mental Disorders: Physiological Causes and Resolutions."

They include:

• Mel Werbach, M.D., author of numerous books including "Nutritional Influences on Mental Illness."
• Hyla Cass, M.D., author of a number of books, including the June 2002-released "Natural Highs: Supplements, Nutrition, and Mind/Body Techniques to Help You Feel Good All the Time."
• Charles Gant, M.D., Ph.D., author of the recently-released "End Your Addiction Now" and "ADD and ADHD: Complementary Medicine Solution."
• Eva Edelman, author of "Natural Healing for Schizophrenia and Other Mental Disorders."

The book signing will take place at 6:00 PM on Saturday, June 15, 2002 at the Hollywood Roosevelt Hotel. The book signing will be open to conference attendees and non-attendees.

More information on the conference is available at AlternativeMentalHealth.com.

I read with great interest Dr. Michael Phelan's editorial, "Physical health of people with severe mental illness". His comments were right on the mark.

The failure to do full medical screenings on psychiatric patients is one of the greatest areas of neglect in modern medicine. As Dr. Phelan cited, studies have repeatedly shown for years that psychiatric populations have more medical ailments than non-psychiatric patients. No one disputes this. And most of those same studies also show that a healthy percentage of psychiatric patients are routinely misdiagnosed with mental illness (and often placed on psychotropics for years or for life), when they, in fact, have medical problems causing or exacerbating their psychiatric symptoms. No one disputes this either.

The landmark 1980 study by Richard Hall et al ("Physical Illness Manifesting as Psychiatric Disease", Arch Gen Psychiatry, 1980, 37: 989- 995) found 46% of the psychiatric patients thoroughly examined had physical ailments causing or exacerbating their mental symptoms.

The California legislature was so shocked by this study, it ordered research, headed by Dr. Lorrin Koran of Stanford University, on how to improve the quality of medical exams in psychiatric settings. The result of that study was the "Medical Evaluation Field Manual", which sets a minimal standard for medical screenings and provides an efficient algorithm when full screenings are not practical.

The manual was distributed to all of California's counties in the late 1980s and NONE of them implemented it. A dozen years later, my nonprofit organization, Safe Harbor, has asked for and received a grant to work on getting this manual implemented.

We have posted the Field Manual on the internet at www.alternativementalhealth.com/articles/fieldmanual.htm.

What concerns me is that I - a layman - and a group of volunteers is having to grab the psychiatric profession by the scruff of the neck to get them to examine their own patients! This does not speak well for the profession or for its organizations such as the American and British Psychiatric Associations.

We have even gone so far as to create a web site - now the largest of its kind in the world - called AlternativeMentalHealth.com to educate the public and medical field on the myriad of physical ailments that can cause psychiatric symptoms.

We are also holding a medical conference in Los Angeles in June (details on our web site) to fill this missing gap in psychiatric education on the importance of physical exams.

This medical negligence cannot continue. I would like to issue a call to medical professionals to, once and for all, set and keep minimal medical screening standards for psychiatric patients so that this easily- remedied medical neglect exists no more.
 

Response by Stuart Shipko, M.D., psychiatrist, neurologist, founder and director of the Panic Disorder Institute (www.algy.com/pdi):

"This is so true. A long time ago when I actively practiced general medicine I was the doctor who did physical examinations on patients confined to a mental ward. I found that the labwork showed excessive abnormalities of calcium, sodium and chloride. I diligently worked up these abnormalities, but concluded that the abnormalities were due to problems in blood testing. To present this to the quality assurance committee I reviewed the charts of the previous 50 admissions and showed the cluster of abnormalities. The response? They wanted to know what my motives were and why I cared. The fact that it was my job to care went over their heads. Medical evaluation of the 'mentally ill' is pretty much nonexistent."

A randomized double-blind, placebo-controlled study, conducted by the University Department of Physiology at Oxford, England, studied the effects of supplementation with highly unsaturated fatty acids (HUFAs) on ADHD-related symptoms in children with specific learning difficulties. The authors tested to determine if relative deficiencies in HUFAs may underlie some of the behavioral and learning problems associated with these symptoms.

Forty-one children aged 8-12 years, with both specific learning difficulties and above-average ADHD ratings, were randomly placed on HUFA supplementation or placebo for 12 weeks.

The authors of the study reported (in Prog Neuropsychopharmacol Biol Psychiatry, 2002 Feb;26(2):233-9) that "At both baseline and follow-up, a range of behavioral and learning problems associated with ADHD was assessed using standardized parent rating scales; at baseline, the groups did not differ, but after 12 weeks mean scores for cognitive problems and general behavior problems were significantly lower for the group treated with HUFA than for the placebo group; there were significant improvements from baseline on 7 out of 14 scales for active treatment, compared with none for placebo."

Their conclusion: "HUFA supplementation appears to reduce ADHD-related symptoms in children with specific learning difficulties. Given the safety and tolerability of this simple treatment, results from this pilot study strongly support the case for further investigations."

As the instruments of laboratory science become more precise, so too does our understanding of how even slight biochemical imbalances in the body may potentially affect human health.

A new study funded by the National Institute of Mental Health reports that as many as two out of every three patients diagnosed with bipolar depression may have sub-optimal thyroid hormone levels. These slight imbalances within the "normal range" appear to make these patients much more resistant to antidepressants.

Researchers measured thyroid hormone levels in 65 patients diagnosed in the depressive phase of bipolar disorder. For the next 50 months, they tracked their recovery after treatment with lithium carbonate and various antidepressant medications.

The association of thyroid dysfunction with depression is not new. What is new is evidence that more subtle thyroid imbalances may have a pronounced effect.

The study found that patients with low normal levels of free thyroxine (T4) index or high normal levels of thyroid-stimulating hormone (TSH) took nearly one year - at least four months longer than patients who had an optimal thyroid profile - to respond to various drug treatments for depression.

The imbalances that produced an effect on treatment outcomes were even milder than those falling under the subclinical definition of hypothyroidism. For this reason, a suboptimal thyroid profile - still within the "normal" range - may be an important modifiable risk factor in bipolar depression.

"Because the thyroid is the main regulator of human metabolism," explains Great Smokies Diagnostic Laboratory, "even slight imbalances can affect a wide range of physiological and psychological conditions, including mood disorders, obesity, chronic fatigue, digestive problems, cognitive and sexual dysfunction, and cardiovascular disease."
 

Source:
	Cole et al, "Slower treatment response in bipolar depression predicted by lower pretreatment thyroid function," American Journal of Psychiatry 2002;159:116-121.

Those who have sought alternative treatment for mental problems, paying hard cash because their health insurers didn't have a billing code for such treatments, are luckier than they may realize.

A new article on insure.com, "Don't Let a Previous Mental Health Claim Ruin Your Health Insurance Prospects," details how those who have filed mental health claims in the past for orthodox psychiatric treatment may now be denied individual health coverage - or pay an exorbitant premium.

Individual insurers may deny coverage based on past counseling for anxiety, depression, grief, or an eating or sleep disorder, or use of prescription drugs to treat anxiety, depression, or a physical condition. Such drugs include Ativan, Klonipin, Paxil, Prozac, Serzone, Zoloft, Xanax, or Wellbutrin.

"People who've always had group health insurance are completely unprepared when they're forced to seek coverage in this [individual health insurance] market," says Karen Pollitz, a Georgetown University researcher who co-authored a 2001 study on the individual health insurance market for the Kaiser Family Foundation. "They think they're going to get the same coverage they had in their jobs, except they'll just have to pay a little more money. It's absolutely not like that at all. The individual health insurance market is unpredictable, inconsistent, and expensive."

Those who are offered an individual health insurance policy may find their coverage comes at a much higher price and excludes any treatment for past or present medical conditions.

Dr. Deborah Peel, president of the National Coalition of Mental Health Professionals and Consumers, recalls a young graduate student whose sleep apnea was treated with antidepressant medication. When he was dropped from his parents' group health insurance plan due to his age, he began applying for a policy in the individual market. He was turned down several times because his medical records showed he had taken an antidepressant - even though the medication was for a physical rather than mental condition.

According to a report published in the March 2002 issue of Pediatrics, a group of researchers have established a link between sleep problems and behavioral problems in children, especially young boys.

The study, is the largest to look into the possible connection between inattention/hyperactivity and sleep.

Ronald D. Chervin, MD, MS, with University of Michigan Medical School, and colleagues surveyed parents of more than 850 boys and girls, aged 2-14, in pediatric waiting rooms.

The researchers asked the parents whether their children exhibited symptoms of attention deficit hyperactivity disorder (ADHD), such as inattention to tasks and schoolwork, distraction, forgetfulness, fidgeting, and excessive talking. They also asked whether the children snored, were often sleepy, or exhibited other symptoms indicative of sleep problems, such as difficulty waking up in the morning or mouth-breathing during the day.

The researchers tallied scores for each symptom or behavior on a sliding scale. Overall, 16% of the kids were frequent snorers and 13% scored high for hyperactivity. Interestingly, 22% of the habitual snorers were hyperactive, compared with only 12% of the infrequent snorers or non-snorers. The same pattern held when they looked at the relationship from the opposite direction.

Next, they stratified the children by age and sex and found that the snoring link was most dramatic in boys under 8 years old. In this group, 30% of regular snorers had high hyperactivity scores, compared with only 9% of less frequent snorers.

"If there is indeed a cause-and-effect link, sleep problems in children could represent a major public health issue," says Chervin in a news release. "It's conceivable that by better identifying and treating children's snoring and other nighttime breathing problems, we could help address some of the most common and challenging childhood behavioral issues."

Dr. Carolyn Hart had this to say in the Dec. 2001 issue of "Attention!":

"Narcolepsy can also coexist with or imitate AD/HD. This is a disorder in which sleep and wakefulness are not cleanly distinct, but intrude on each other. This too should be diagnosed with PSG [Polysomnogram: a measure of various physiological responses during sleep]...

"Nocturnal seizures and allergy symptoms are two medical causes of sleep disruption. Both usually give daytime clues too, but often allergy symptoms worsen at night and seizures might only occur during deep sleep so parents may not be aware of these problems. Electroencephalogram (EEG) monitoring, PSG, and allergy testing should be considered if fatigue and inattention seem resistant to treatment efforts. One young teen was brought to me for an evaluation regarding suspected AD/HD; she fell asleep sitting in my tenth floor window seat, drooling down the window, while her parents told me her life story. She turned out to have nocturnal allergy symptoms and not AD/HD."

Are you currently struggling to overcome a drug or alcohol problem? Or do you have a friend or family member who is? Or are you currently in recovery but having difficulty staying clean and sober? Barnes & Noble University now offers a free online course to help you understand the biochemical basis of substance problems. More importantly, it provides a practical step-by-step program for overcoming addiction by using common nutritional supplements to correct the biochemical imbalances that are causing it.

Whether you're trying to quit smoking, or are having difficulty stopping the use of prescription antidepressants or painkillers, or want to stop or cut down your use of alcohol and other "recreational" drugs, this course is for you. You'll learn how to restore the normal production of important brain chemicals your substance use has disrupted and how to rid your body of toxins that are keeping you from enjoying the good health that nature intended.

Prerequisites: none.

Objectives:

• Understand why traditional approaches to treating drug and alcohol problems fail for more than 70 percent of the people who try them.
• Understand how disruptions in the production of important brain chemicals called "neurotransmitters" are the cause of substance problems.
• Use nutritional supplements to restore the nutrients that enable your brain to resume the normal and healthy production of these neurotransmitters.
• Use nutritional supplements to remove the toxins which can cause mood swings, sleep problem, and substance cravings, and which often prevent substance abusers from recovering.
• Change your life by becoming a healthier, happier person who no longer must rely on cigarettes, drugs, or alcohol to feel good.

Course Creator and Instructor: Charles Gant and Greg Lewis

Start/End Dates: May 7-June 14

The fumes from glue, lighters, and solvents that children and young adults inhale go straight to the same brain regions that are stimulated by cocaine and other drugs, researchers announced in mid-April 2002

Brain scans show that chemicals such as toluene move rapidly to pleasure centers, then move out to other brain cells, causing the memory loss, vision problems, and serious mental defects well known to result from the practice of sniffing ("huffing").

Reuters quoted neuroanatomist Stephen Dewey of Brookhaven National Laboratory as follows:

"We have known it from behavioral studies - people will report euphoria and they will report highs. But we have never known this class of chemicals, these toluenes, go to the dopamine centers of the brain, much like cocaine."

Unlike illegal drugs such as cocaine, solvents are everywhere and easily accessed by youngsters who quickly learn they can give a cheap high.

"I get questions from fourth, fifth, sixth graders. They huff butane lighters," he said. "The most striking latest statistics suggest that 1 in 5 eighth graders have done it."

Writing in the journal Life Sciences, Dewey and colleagues said they injected toluene, the chemical that causes the "high" from sniffing, into baboons and then did PET scans of their brains and bodies.

The chemical went straight to clusters of brain cells that produce dopamine, a neurotransmitter or message-carrying chemical associated with pleasure.

"Then we watched it redistribute to the white matter in the brain. And it goes to the kidneys just as quickly," Dewey said.

This could explain the toxic side-effects of huffing or sniffing. "What you see is over time is you get cortical atrophy, characterized by changes in cognition, disorientation," Dewey said. Vision becomes blurred and victims can become uncoordinated.