Lecture 2, June 2nd - Dr

1INTEGRATED CLINICAL STUDIES – JUNE 2ND, 2008 DR. KIMBERLEE BLYDEN TAYLOR – NATUROPATHIC APPROACHES TO PATIENTS WITH MOOD DISORDERS LECTURE 2 Required readings: gives us some background info for conditions discussed. Bipolar in men: typical delusions of grandeur etc. With women, children, may be seen as irritability, anger. Bipolar and depression sxs: linked to low levels of serotonin, norepinephrine, catecholamines? Highly debated, even though we give meds to address these receptors specifically. Can’t measure serotonin levels, so diagnosis made on symptoms alone. Drugs seem to work in the majority of people (but not in the majority of the time). People have to change meds. Anti-epileptic drugs used for mood disorders (off-label use) Bipolar clinic at CAMH: much of experimentation with meds being done in Toronto. • Is this a good idea? Patients are very ill, not responding to conventional treatments, so other options are tried. • Drugs used in combination: anti-epileptics were used with anti-depressants. Now anti-epileptics used alone. • Much higher doses are being used: levels used were previously given to in-patients only. Lack of complete knowledge in this field. Why are peole reacting in unpredictable (positive) ways to these drugs? Lots for us to learn still. DEPRESSION: (page 2) Re: DDX list (page 2): These conditions can overlie each other. Linked with CV disease: not sure of causal direction Asthma, anemia: link here too. Pain response is improved when depression is treated. Patient with depression along with physical ailment: hospital stay will be longer. ANXIETY (page 1): Symptoms may be only physical on presentation. Will see anxiety with depression. Anxiety can mask depression. Symptoms tend to be more severe. May have ‘patient that presents well’: tell you about all of their symptoms clearly, rationally, objectively. Not presenting how you may expect: teary, agitated, hard to get info from. Often underdiagnosed, go untreated. DDX: may not fit into to 9 primary anxiety disorders, but this doesn’t mean that the disorder is any less disruptive for them. Substance abuse common in people with poorly-treated mood disorder. Patients will only be as open as we can be. If we seem tense about certain areas, patients pick up on this, it is harder for them to express their feelings in this area. Especially with mood disorders: more sensitive to being judged, categorized. Substances help them deal with their symptoms. Alcohol, marijuana… Can mask a psychiatric presentation: it is a way of dealing with symptoms. Important to recognize why people may be using substances to cope with symptoms. Culturally bound disorders: things that are prevalent in specific cultures. Eg.: Anorexia, acute stress disorder, agoraphobia not seen much outside of “first world” countries. B12 deficiency, hypoglycemia can cause anxiety. Lung disease: high association with anxiety. Common link between many of these disorders: lack of oxygen. Anticonvulsants: used as mood stabilizers! Birth control pill: Hard to get anxiety under control without going off pill, if this is causing anxiety Bronchodilators: steroid-based compounds, have stimulants in them Withdrawal from drugs: includes antidepressants MANIA (Page 3) PSYCHOSIS Pancreatitis, pellagra Idea that psych diseases appear on a continuum: can anxiety, mania leads to psychosis? Screen to rule out organic causes. “STD” should be “STI”: inquire after you have rapport with patient. ICS JUNE 2ND, 2008 – PAGE 1

Cultural meanings and mental illness: the way that patients describe their symptoms is determined by their cultural experience. DSM written in North America, Europe, written at universities, based on these populations, written by men. Biases inherent in this document. (DSM-IV is better in this way). Women, children present differently. Rethinking Psychiatry Kleinman, 1988 Mental illness: still lots of taboo associated with it. Eg. People with depression may be absent more often from work. This would be seen differently than if they were taking time off for diabetes, cancer. Psychiatric Pride: working with society to challenge perceptions of mental illness. Bringing together community that tends to be dispersed. www.madpridetoronto.com Case of Mrs. Wu: symptoms began suddenly, for no reason (Biomedical?). Stuck. Mother in law lives with her: told to endure. Neuraesthenia: lack of sleep, etc (other signs of anxiety). “Interferes with her duties as a wife and mother-inlaw”. Given Valium and herbs. Told to swallow her anger. Diagnosis doesn’t ‘blame’ anyone, taken away potential for lack of respect, given treatment that gains trust, respect of patient and family. Patients who trust their practitioner do better with maintenance, remission of symptoms. Page 4: Quotes from “essential papers on suicide” Suicidal ideation is extreme that triggers everyone. We as practitioners may be triggered by this and it may interfere with our treatment. How do we respond to patients that trigger us? “the therapist’s response” SPIRITUALITY May provide an important resource for patients. This may trigger practitioners: be aware. We may not agree with it, but it may be incredibly important to patient! Statements from Freud and Ellis: suggest that religious affiliation is sign of less emotional health… “Basic principle” is more along the lines of how we can work with patients. TCM – See Maciocia: The practice of Chinese medicine. The treatment of diseases with acupuncture and medicinal herbs (‘the gold book’) Page 5: Food allergies: may see a greenish colour around mouth. Forehead: this is where the shen is Mind weakened: location of deficiency will depend on where individual weakness is. Phlegm: frank pathology. LV Yin deficiency with empty heat: Hypertension, migraines, skin pathologies, PMS, dysmenorrhea. Most severe category is “Mind obstructed”. Obstructed by phlegm, stagnation. Western diagnoses seen with Phlegm heat harassing the mind: brain tumours, kidney failure, severe CV problems. Acupuncture “spirit points”: used for psychiatric presentations. UB 52: outer back-shu of kidney, use with UB 23, GV4. Mental/emotional fortitude. UB 44: another outer back-shu point: these are all good for emotional issues. GV20: moves everything up. Also working with two upper charkas with this point. LU5: YIN. While doing acupuncture on the body, can do acupuncture on the head. Any therapeutic touch is incredibly supportive Mind unsettled: if LV is affected, GB will be affected too. GB15: would likely have to do regular (daily?) treatment to have this effect. PC6: Dr. BT has seen this slow patient’s talk during treatment, and not when it is not used. Chlorophyll!!! Helps increase O2. ICS JUNE 2ND, 2008 – PAGE 2

Homeopathy: phenomenal with emotional/psychiatric issues. Person who is delusional: flipping back and forth between subjects… How do you find a remedy for them? Observe symptoms. Perhaps more objective, look for patterns in delusions. Like with kids, animals, look for patterns! What is the primary area of concern? Are symptoms verbal, physical? Are curses religious? Sexual? “Shit”? (lac caninum). Listen to what they say between the answers to their questions… “Oh, I don’t know… yeah, well, maybe… I always act this way/feel this way… God, I’m so stupid…” Can give you a lot of information. Solanaceae: big category of psychiatric remedies. Belladonna: throbbing heat, like LV picture. Sudden, dramatic, violent. Capsicum: lots of burning, rage, homesickness. Not wanting to be where we are at any one time. I feel half-dead: papavaraceae family. Numbness: morphine, codeine, cocaine. Cactaceae: hallucinogenics. Think of constricted, tightness. Anhalonium: delusional symptoms. Mixing of senses. People will talk about how they can sense colours using senses other than sight. (eg. May see this in musicians). Can feel, hear colours. Anacardium: hatred, cursing. Trapped: think of birds. Bird remedies: Many psych remedies have feeling of inferiority. What are the things that people do all the time? These are the things that make them feel better. Can observe these things. Constantly moving? Probably better movement. Cygnus: proved by Jeremy Sherr Proves very easily… Red-tailed hawk Great for extreme depression, bipolar. Doesn’t look like classic bipolar, but women/children may show more anger, rage with violence when affected by bipolar. Conflict with desire to be free with obligation, responsibility. Falcon: like Buteo, but without violence. Haliaeetus: think Hannibal Lector: brilliance even in depths of psychosis. Lac remedies: May see this in child needing to take parenting role (parent ill, dependent on substance…) Carcinosum: personality breaks down completely. Overprescribed because of fastidiousness. Should be used when this quality is result of out of control situation. DDX Arsenicum: may not have the out of control situation. Feel calm when they control. www.hominf.org Drug provings on this site. Chocolate: this is a DRUG remedy! Hydrogen: talking to God. “Almost gone”. Helium: a bit closer to the ground. AIDS miasm: the next major miasm to develop in the world. Extreme feeling of isolation. Vulnerable, unprotected, SHAME.

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