Mental Illness

LeClaire family’s tragedy has brought attention to the challenges facing the mental health care system. And the Canadian Psychiatric Association says that the needs of people diagnosed with a mental illness have been neglected for far too long.

What is the extent of the problem?

Mental illness makes up three of the top five reasons for which Albertans saw physicians in the year 1999-2000 (Alberta’s Health System – Some Performance Indicators, November, 2000).

Here is the list of top five reasons:

1. Neurotic disorder (e.g. anxiety, stress): 15 percent
2. Depressive disorders (e.g. depression): 15 percent
3. General symptoms: 14 percent
4. High blood pressure: 11 percent
5. Affective psychoses (serious mental illnesses): 9 percent

The 1946 constitution of the World Health Organization defines health as state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. Mental hygiene means the science of maintaining mental health and preventing the development of psychosis (loss of contact with reality), neurosis (symptoms of hysteria, anxiety, obsessions and compulsions), or other mental disorders.

Mental illness is not new. The earliest known mental hospitals were established in the Arab world, in Baghdad (ad 918) and in Cairo. Through the ages the mentally challenged have been viewed with a mixture of fear and revulsion. Their fate generally has been one of rejection, neglect and ill treatment.

In 1993, a study showed that Canadian youth who experienced mental health problems were more likely to turn to other youth for help rather than to the mental health system. About 15 to 25 percent of teenagers have psychiatric problems; but only one in six gets any treatment.

The Canadian Psychiatric Association (CPA) says that one in five Canadians can expect to experience a mental illness sometime in their lives. Sixteen percent of health care expenditures are spent to look after psychiatric disorders. Almost 4,000 people a year commit suicide. One in ten people at some point in their lives is seriously affected by depression, a leading illness among women 15 to 44 years old.

The CPA feels that inadequate funding is a big problem. For example, 40 percent of patients’ visits to family physicians are related to emotional issues, yet less than four percent of medical research funding is directed to psychiatric conditions in Canada.
The funding and policies relating to mental health needs to be geared to support and create evidence based patient care. But, the CPA says, this adage has not been applied to the mental health system. Many people feel that mental health remains a second-class cousin within the health care system.

What is the solution?

The CPA’s web site (http://cpa.medical.org) says, “The persistent stigma associated with mental illness and the challenges facing the mental health care system require a strong united voice both among those who work on the front lines and those who live with mental illness.”

If you feel that the mental health care system has failed you or your loved one then contact the Canadian Psychiatric Association through their web page listed in the previous paragraph or phone 613-234-2815 or fax 613-234-9857 and lend your support to help change attitudes about mental illness and to improve the system.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

Dear Dr. B: What causes Raynaud’s disease and what can I use to lessen the symptoms? Yours, A Regular Reader (RR).

Dear RR: Maurice Raynaud (1834-1881), a physician and professor in Paris, first wrote his thesis on this subject in 1862.

Raynaud’s disease defines a condition characterized by episodic spasm of blood vessels (arteries and arterioles) in the hands and feet. The spasm of the blood vessels is triggered by exposure to cold or emotional stimuli. This results in closure of the small arteries. Fingers and hands are more frequently involved than toes and feet.

The classical syndrome consists of intense blanching of the fingertips, followed by cyanosis (bluish tinge of the skin due to lack of oxygen), followed by redness on the fingertips due to rewarming and return of oxygenated blood, with full recovery occurring in 15 to 45 minutes. This typical pattern occurs only in a small number of patients. Most patients have milder form of the disease. Blanching of the fingers is associated with pain.

Why do some people have sensitive blood vessels?

The mechanism of vessel spasm that occurs during an episode of Raynaud’s disease has interested many investigators for more than a century. But nobody has given a satisfactory answer. The role of nervous system remains unclear.

What percentage of people is affected by this condition?

This is hard to estimate in general population. But people who live in cool damp climates seem to have higher incidence (20-25 percent). People in certain occupations have higher incidence as well. About 40 to 90 percent of chainsaw operators and miners using vibrating equipment have Raynaud’s syndrome. Food workers who work in cold areas have about 50 percent incidence of this disease.

Women constitute 70 to 90 percent of most reported patients with Raynaud’s syndrome, says Sabiston’s Textbook of Surgery (15th Edition). Usually these are younger women typically under 30 years of age.

About 44 percent of patients with Raynaud’s have no underlying cause (idiopathic) i.e. not related to occupation or underlying diseases like autoimmune and atherosclerosis (hardening of the arteries). When it occurs as a complication of another disease, it is called Raynaud’s phenomenon.

The diagnosis of Raynaud’s disease is made by history, physical examination and specialized laboratory tests. Again, the tests not very specific.

RR asks: what can I do to lessen the symptoms?

Most patients with Raynaud’s syndrome have only mild symptoms, which respond well to simple conservative treatment, including wearing of warm clothes and gloves. Avoid cold environment. Do not smoke. About 10 percent of patients have sufficiently severe and frequent episodes to require drug therapy. Vasodilators are most frequently used. But none of the drugs have been properly evaluated.

Surgical treatment in the form of sympathectomy (division of autonomic nervous system) causes dramatic improvement in occasional patient but can be unpredictable and disappointing.

RR, 140 years have gone by since Maurice Raynaud described this condition. I am not sure whether I have answered your question satisfactorily. But in a nutshell, my highly intellectual and scientific advice is – avoid cold environment, do not smoke and keep your hands warm!

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

Falls and Fractures

Soon to be 90, the former U.S. president, Ronald Reagan, falls at home and breaks a hip. A middle-aged physician falls in his back yard and breaks his arm. A young nurse falls in the hospital parking lot and breaks an ankle. A teenager falls on the ski hill and breaks a wrist. A child trips and falls down and cracks his skull.

All this happens within a few days. You wonder who is going to be next? Is anybody immune to falls and injuries? No! Falls account for 75 percent of all injury-related in-hospital deaths. And our seniors are at high risk.

One-third of Canadians admitted to hospital with an injury are aged 65 or older. Approximately, 60 percent of persons who die from falls are 65 years old or older, and falls account for 87 percent of all fractures in older adults.

You may say, “Enough of statistics, Doc! What’s your point?”

The point is that 90 percent of injuries are predictable and preventable. And we can do a lot to prevent our seniors getting hurt.

It is not unusual to see one of our local seniors walking on a wintry slippery road to catch a bus or go shopping. The next thing you hear is that grandpa fell on icy roads and broke a hip.

I know some businesses do provide delivery services to our seniors for a fee. Are all businesses doing the same? Are seniors aware of these services and taking advantage of it?

This is just one example of how seniors are at risk of hurting themselves. Studies have shown there are many reasons why seniors fall and break their bones. And it is not always on icy roads. And there is a lot we can do to prevent this happening.

Hip fracture is the most frequent serious consequence of falling among seniors. Osteoporosis is one of the main reasons. Can we prevent osteoporosis?

Prevention of osteoporosis should start in childhood with an adequate intake of calcium, says an article in the New England Journal of Medicine. Hormone replacement therapy (25 percent reduction in hip fractures), calcium and vitamin D supplements in later life (23 percent reduction in hip fractures), active weight-bearing exercises (40-50 percent reduction in hip fractures), and combining these programs with balance training reduces osteoporosis and the risk of hip fractures, says the article.

Multimodal programs and interventions have shown success in preventing fall among the seniors. Home visit by a nurse and a physical therapist can assess and treat postural drop in blood pressure, discontinue sedatives and other medications which impair balance and walking, eliminate or modify hazards in the home, encourage exercise programs and gait training, and plan behavioural modification. These actions can reduce the risk of falling by 31 percent.

One thing we cannot control is the weather and slippery road conditions. Here the prevention is to stay home and seek help from family, friends and neighbours.

Nobody is immune to falls and fractures. But our seniors are the most vulnerable. Let us help them stay healthy and well. And they have to learn to ask for help. If you don’t ask then you don’t get it!

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

ELMOSS

Each year, I make New Year’s resolutions. Often, I cannot accomplish them all. But for many reasons, the year 2000 was a good one for me. I tried to follow what I wrote in my column on January 1st, 2000. I said that if we take good care of ELMOS then ELMOS will take care of many of the health problems that affect us.

What does ELMOS stand for?

E stands for exercise, L for laughter, M for meditation, O for organic healthy food, and S for stress relief. You can help yourself with ELMOS. It is based on our own time, our own determination and our own dedication.

So, how did I do in 2000?

Exercise: I have been using my treadmill. But not as much as I would like to. Experts recommend moderately intense exercise daily at least for 30 minutes. I have been pretty close but I hope to do better this year. If you are new to exercise then remember to warm up and cool down. Know your limitation and check with your doctor if you are not sure.

Laughter: I haven’t been laughing much last year. I have been too busy taking care of other things. But this year I want to laugh a lot. Laughter is the best medicine. It is cheap. And it can be infectious. So let us plan to laugh a lot and spread it around.

Meditation: A quotation from Blaise Pascal (a French philosopher, scientist, mathematician, and writer) says it all, “All man’s miseries derive from not being able to sit quietly in a room alone.”

Meditation is defined as private devotion or mental exercise consisting in any of innumerable techniques of concentration. Like many of you, I do practice some sort of meditation each day but not enough to benefit my health. May be half an hour of silence with eyes shut in a room alone (with soft music or relaxation tape or a rosary) is what I should aim for this year.

Organic healthy food: It is not always easy to find organic food, says my wife. And it is expensive. But she tries hard to buy whatever she can find. Maybe one day we will have a supermarket full of organic food. I eat 5 to 10 servings of vegetables and fruit daily. I stick to low fat and high fibre diet. But what bothers me most is the amount of fried food and sweet stuff lying all over the place. Sometimes at home, most of the time at work, in cafeterias and restaurants. This year my target is to cut down further on sweet stuff (good bye to my favourite chocolate chip peanut butter cookie!).

Stress relief: Life without stress is not possible. Stress is part of our life. Some people take up smoking, drinking alcohol or coffee, and eating junk food as an escape from stress. I try exercise, laughter, a good movie or a book, massage therapy, or swimming with few minutes in the whirlpool. I find water very relaxing. I expect my stress level to be little less this year if I can control my time.

Looks like I have some work to do this year. Perhaps you too. Why don’t you make a list of your plans and stick it somewhere where you can see it everyday? You may send me a copy if you like. Apply the KISS principle – keep it simple stupid!

Good luck and happy New Year.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!