Lights, Camera, Recovery – Addiction, Intervention and Recovery

Pine Rest is pleased to present Lights, Camera, Recovery, featuring the Emmy Award winning producer Kurt Schemper. Kurt, a Grand Rapids native, will premiere clips of the Emmy Award winning A&E television show, Intervention – a reality show that portrays the trauma of addictions and the challenging path to recovery. Kurt is eager to share the message that addictions can be treated and recovery is possible.

“Stop the Cycle” Video

We invite you to join us:

Date: Thursday, September 13, 2012

Location: Celebration! Cinema North | Map

Time: 6:30 p.m. Reception ~ Hors d’oeuvres

7:30 p.m. Theatre Premiere

Tickets: $75 per person | Buy Tickets

Attire: Business

For more information contact: Marcia Timmerman at 616-281-6390 or Marcia.Timmerman@pinerest.org.

Proceeds from the event will benefit these Pine Rest programs:

Complete a facility project for the Intensive Outpatient Program.

Provide funding to initiate Trauma Informed Care treatment in our Substance Use Disorder Residential Program.
Allow access to Detox services for clients with financial hardship.

Seminar: Clinical Care of the Client with Perinatal Mood Disorder

Clinical Care of the Client with Perinatal Mood Disorder
Date & Time
5/18/2012
Location
Pine Rest Postma Center, 300 68th Street SE, Grand Rapids 49548

Time: 8:15 a.m. – 4 p.m.

Contact: 616/222-4566

Cost: $90 seminar & lunch; $25 lunch only; no charge for Pine Rest staff

Registration deadline: May 4, 2012

Purpose Statement
“Clinical Care of the Client with PMD” is a conference designed to educate physicians, nurses, social workers, psychologists, therapists, and care providers on defining and recognizing Perinatal Mood Disorder while discussing current medications and therapeutic interventions that effectively manage this disorder.

Course Objectives
At the completion of this course, participants should be able to verbalize strategies for screening perinatal mood disorders, cite appropriate pharmacologic treatment options, understand the need for mother/baby bonding, and identify resources available as treatment options.

Key Note Speaker: Maria Muzik, MD, MS

Dr. Muzik completed her medical training in psychiatry at the University of Vienna in Austria, and the University of Michigan. She also holds a master’s degree in Clinical Research and Statistical Analysis from the University of Michigan. She is a certified psychotherapist and a research fellow with the International Psychoanalytic Association. She directs the University of Michigan Department of Psychiatry Perinatal Clinic and Parent-Infant Program, and serves as a perinatal psychiatry consultant at an Adolescent Youth Clinic in the community. She conducts research and provides clinical care. Clinically she focuses on work with mothers suffering from anxiety, trauma and depression during pregnancy and postpartum, and their infants or young children.

Who Should Attend
Physicians, physician assistants, nurse practitioners, registered nurses, nurse midwives, licensed practical nurses, social workers, mental health professionals, home health workers, and others involved in the care of women are invited.

Agenda

8:15 – 8:45 a.m. Registration

8:45 a.m. Opening Remarks

9:00 a.m. Responsible PPD Screening: Rationale, Timing, and Follow Up
The prognosis for a complete recovery from a Perinatal Mood Disorder is contingent on early screening and intervention. It is important for providers to know how to screen new mothers in a variety of healthcare settings. It is imperative for them to have a good understanding of the various screening tools that will be introduced in this presentation and how to administer them with comfort and accuracy. Discussion regarding screening barriers, challenges, and benefits will be included and actively debated.
Presented by Nancy Roberts, RN CCE

10:00 a.m. Perinatal Psychosis
This one hour presentation is designed to define, recognize, and treat Postpartum Psychosis. Attendees will learn to identify risk factors, symptoms and behavior in pregnant and postpartum women that occur in psychosis. Interventions, treatment and referral options will also be presented. Presented by Megan Auffrey-Zambiasi, MA LLP/LPC

11:00 a.m. Break and networking

11:30 a.m. Lunch and Keynote: Medication Management of Women with Perinatal Mood Disorders
Pregnancy and the peri-partum period do not protect women from mental illness or addiction. Childbirth has consistently shown over the centuries to be a potent trigger for mood disorders, anxiety, psychosis and relapse of substance use. The management of childbearing women with mental illness and addiction is challenging, requiring the healthcare provider to maintain maternal wellbeing during the pregnancy, while preventing postnatal recurrences and harm to the fetal/infant development. Healthcare providers working with childbearing women are asked to be knowledgeable in detecting early signs and symptoms of perinatal mental illness and substance use, understand the consequences of untreated perinatal illness on child development, support women in obtaining the appropriate medical attention necessary to promote optimal mother/infant outcomes and recognize the impact addiction has in choices made in life.
Presented by Maria Muzik, MD, MS

12:45 p.m. Addictions during Pregnancy: Detection, Consequences, and Treatment
It is a well established fact that mothers with substance use disorders and their children are at higher risk for myriad problems that threaten their health and wellbeing. Exposure of the developing fetus to psychoactive drugs in utero is a leading cause of mental, physical, psychological and sociological problems in infants and children. In the prenatal period, maternal substance use can lead to fetal growth restriction, abnormal fetal neurologic development and increased risk of preterm labor. The goal of this presentation is to introduce the audience to main substance categories abused during pregnancy and to elaborate on the impact of such abuse on a developing child. Screening and treatment options will be discussed as well.
Presented by Maria Muzik, MD, MS

1:45 p.m. Perinatal Mood Disorder and its Impact on the Parent-Infant Relationship
We’ve learned that babies mirror what they see in their mothers’ faces. The dance of mirroring can be rich and a nurturing experience when the infant looks into the face that is animated, loving, and readily available. It in turn can be a stressful, empty and anxiety producing experience for the baby. This session reviews ways that PMD affects infants, looks at problems that can occur within this dyad in the areas of bonding, attachment and for the infant specifically in his/her ability to learn how to self-regulate. Further, issues with cognitive impairment can occur in the infant. We’ll look at ways to improve the outcome for baby, mother and the dyad together.
Presented by Mary Beth Reimer, LBSW, MA, IMH-E(IV)

3:15 p.m. Break

3:30 p.m. “Through the Blue”
Sara and Jeff Tow will talk about both of their experiences suffering from postpartum depression after the birth of their two children. They will touch on how families are affected, the myth that dads can’t have Postpartum Depression, and why there is no need to suffer in silence, as they did. This difficult period in their lives is what is leading them to swim across Lake Michigan to raise awareness of this often misunderstood and misdiagnosed mental illness.
Presented by Jeff and Sara Tow

Special Note: You can help Sara and Jeff succeed in their “Through the Blue” journey and campaign. Please visit http://www.throughtheblue.org or http://www.throughtheblue.org/get-involved/items-needed-donations/ to learn more, and bring an item to the conference!

4:00 p.m. Wrap up and evaluations

Continuing Education
Nursing 5.5 contact hours may be provided. St. Joseph Mercy Health System is an approved provider of continuing nursing education by the Wisconsin Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Planning Committee: Theresa Heindlmeyer, BSN, RN_BC; Megan Auffrey-Zambiasi, M.A./L.L.P./L.P.C.; Gretchen Johnson MSN, RN-BC; Scott Wagner, MSW, MBA, Sharon Chapin, BA.

5.5 credit hours offered for Social Workers. Pine Rest Christian Mental Health Services is an approved provider with the Michigan Social Work Continuing Education Collaborative. Approved Provider Number: MICEC-0047. CE hours are recognized by the Michigan Board of Social Work.

Location
The Postma Center
Pine Rest Christian Mental Health Services
300 68th Street SE
Grand Rapids, MI 49548

The Center is conveniently located off M-6 and US-131. Free parking on-site.

From Detroit/Lansing: Take Interstate 96 West through Lansing toward Grand Rapids. Take M-6 68th Street. Turn right/west on 68th Street. Pine Rest’s campus is located between Madison and Division Avenues on the south side of 68th Street.

From Chicago: Take Interstate 94 East. Merge onto I-196 North toward Holland / Grand Rapids (Exit 34). Take the M-6 East exit toward Lansing (Exit 64). Take the 68th Street / US-131 S exit toward Kalamazoo (Exit 8). Turn left/east on 68th Street. Pine Rest’s campus is located between Madison and Division Avenues on the south side of 68th Street.

From the North: Take US-131 South toward Grand Rapids. Take the 68th Street exit toward Cutlerville (Exit 76). Turn left/east on 68th Street. Pine Rest’s campus is one mile east of US-131 on the south side of 68th Street.

From the South: Take US-131 North toward Grand Rapids. Take the 68th Street exit toward Cutlerville (Exit 77). Turn right/east on 68th Street. Pine Rest’s campus is located between Madison and Division Avenues on the south side of 68th Street.

Options & Fees

Seminar & Lunch $90

Lunch Only $25

Deadline for registration is May 4, 2012

No refunds provided after May 4, 2012

Click Here to Register

Electroconvulsive Therapy Can Be A Lifeline In Treating Major Depression

Donna Ecklesdafer, MSN, RN

When you think about a defibrillator, most people think about an up to the date, state of the art and life saving treatment. When you think about Electroconvulsive Therapy (ECT), do you think about the 1940’s and the movie “One Flew Over the Cuckoo’s Nest”? The stigma of mental illness and ECT is still prevalent.

ECT is a safe and effective treatment in treating the debilitating symptoms of major depression, bipolar disorder (mania and depression), some forms of schizophrenia, dementia with an underlying mood disorder, among other diagnoses. It can be a life saving treatment if a rapid response is needed.

Major depression affects many people. Nearly 15 million adults in the United States deal with major depression each year. Major depression is the leading cause of disability for individuals ages 15 – 44.

Many people respond to medication and talk therapy. Some, however, do not. ECT is a lifeline for these individuals.

ECT helps to improve or even eliminate the depression symptoms an individual is experiencing. The benefits of ECT include: improved mood, increased pleasure, more restful sleep, better appetite, more positive attitude, less agitation, increased sexual interest, more energy, clearer thinking and more hope.

ECT is similar to medications, however it works faster. A series of 6 – 12 treatments is given three times each week over a period of 4 – 5 weeks. The national average for a series is 10 treatments. Each person is assessed for their response to ECT.

People begin to see an improvement after 4 – 6 ECT treatments or in about 1½ to 2 weeks. Others tend to see improvement before the patient does. When the patient first begins ECT, they may be isolative, have poor eye contact and say just a few words. After a few treatments, they may begin to smile. After a few more treatments, they may start laughing. It is wonderful to see the improvements people can experience with ECT.

A number of improvements and advancements have occurred in ECT just as they have in surgery over the years. A treatment team made up of an anesthesiologist, psychiatrist, and registered nurse (RN) will care for each patient. The patient receives a brief anesthetic medication to put them off to sleep.

Once the patient is asleep, a brief electrical stimulus is given to the brain which causes a grand mal seizure. Because a muscle relaxer is given, very little muscle movement is visible, typically just the hands and feet move. The seizure is monitored by an electroencephalogram (EEG). Once the patient wakes up from anesthesia, they are transferred to the recovery room. The patient’s vital signs are monitored throughout their stay in the ECT Clinic.

Seizure activity in the brain causes chemical changes to take place, not the electricity. These chemical changes improve the patient’s mood symptoms.

ECT is not 100% effective. Once the patient has gone through an acute series of treatments, they must remain on medications or in some circumstances maintenance ECT to keep the gains they made. There is an 80% chance of relapse if the individual does not follow up with either medications or ECT.

Side effects of ECT include headache, muscle aches (due to the muscle relaxant as it contracts muscles before relaxing them), nausea, confusion, short and/or long term memory. Many patients do not experience any of these symptoms. Medications can be given to treat some of the side effects. Typically, the patient may have gaps in their memory right around the time of treatments – right before, during and after.

Education about ECT is vital. Patients and their family are given a video to watch as well as education by an RN. Booklets and an article written on ECT are also given as part of the education packet.

ECT has been proven to be a safe and effective treatment, especially when medications have been ineffective. It is a great option for these individuals. For some, it can be a life saving treatment.

Pine Rest’s ECT Clinic is the only outpatient clinic in the area. For more information, please contact the Pine Rest ECT Clinic at 616-281-6341.

The National Institute of Mental Health (NIMH) latest statistics on suicide (2007):
Suicide was the 4th cause of death in adults ages 18 – 65
34,598 cases reported
Out of these cases, over 90% were diagnosed with Depressive Disorder or Substance Abuse Disorder
The overall rate was 11.3 suicide deaths per 100,000 people
An estimated 11 attempted suicides occur per every suicide death

Donna Ecklesdafer, MSN, RN

Donna Ecklesdafer, MSN, RN, has been the Pine Rest ECT Clinic Manager for the past 16 years and certified in ECT since 2001. Donna co-edited the chapter on ECT with Wayne Creelman, MD, for the book: Drug Interactions in Psychiatry, 3rd edition, by Domenic A Ciraulo, Richard Il Shader, David J. Greenblatt, and Wayne Creelman, published by Lippincott Williams & Wilkins, 2006.

SuperMom

And Other Risk Factors for Postpartum Depression

I really don’t know of any women who go into pregnancy wanting or expecting to be a bad mom. We want to do it all: have the baby, get back in shape, feel rested and refreshed, have a clean house, healthy meals for the family, start the new baby in music, swim, sign language classes, and all of this while having a great hair day.

This may be a bit of an exaggeration, but many women set very high expectations for themselves during pregnancy and after the baby is born. When these expectations are not met (and in reality they rarely are), women feel disappointed, discouraged, and even feel as though they have failed.

The “SuperMom” complex is one of many psychological/social risk factors for postpartum depression. A few other psychological risk factors include:

Life Style Changes – For instance, relationship with friends who do not have children will change. New moms and dads will not be able to pick up and go whenever they want any more. Parents may not have time for activities they once enjoyed.

Life Stressors: Any major life stressor will increase the risk for postpartum depression. Moving, starting a new job, death of a loved one, major family illness, financial problems, and divorce (to name a few) can trigger depression in anyone. Add caring for a new baby, loss of sleep, and fluctuating hormones and you can see why the risk increases!

History of Trauma: If the new mom has experienced abuse of any kind, rape, neglect as a child, or any other trauma, caregivers and loved ones should watch carefully for signs and symptoms of depression. Click here for the signs of perinatal mood disorder.

One of the best things we can do for women is reminding they don’t need to be perfect. We can re-define what it means to be SuperMom. It doesn’t mean that she has to have a perfect house, perfect body, perfect meals, and perfect baby. It may mean there are days when SuperMom doesn’t make dinner on time (or lets dad order out) or the house may stay messy or someone else needs to do laundry. SuperMom may decide to take a nap instead of cleaning the bathroom when the baby is sleeping because she needs to rest. Being SuperMom means she is able to care for herself and the baby and get help when she needs it. Help out by encouraging a SuperMom to care for herself today (or bring her dinner, do her laundry, play with the baby so she can rest, vacuum the floor, or just point out to her what she is doing well).

Postpartum depression is serious, impacting around 15% of women: here are some resources if you or someone you love is suffering:
www.postpartum.net
www.postpartumprogress.com
www.momsbloom.org
www.spectrum-health.org/postpartumdepression
www.postpartumstress.com

Gretchen Johnson,

Gretchen Johnson MSN, RN-BC, manages an inpatient unit and
the Adult Partial Hospital program at Pine Rest Christian Mental
Health. She is a member of the Healthy Kent 2020 Perinatal Mood
Disorder Coalition, American Psychiatric Nurses Association, and
the Psychiatric Nursing Council of Southwest Michigan.

Anxiety & Panic – Is it a 4 Alarm Fire or Burnt Toast?

Our bodies are like a house. There are a variety of spaces and systems that fill needs and perform necessary functions. Anxiety is your body’s warning system, its like a smoke alarm – it goes off for a real fire or just because the toast is burning. It’s not a smart system. You have to take a step back to evaluate the situation and determine if it’s really a crisis requiring action or just burnt toast, simply requiring you to turn the alarm off.

Anxiety is a normal part of life. It can even be useful when it alerts us to danger. For some people however, anxiety is not a reaction to real danger and becomes a persistent problem that interferes with daily activities such as work, school or sleep. This type of anxiety can disrupt relationships and enjoyment of life, and over time it can lead to health concerns and other problems.

The “fire” of anxiety – how it physically affects people can be different for each of us. Some have trouble sleeping, some get headaches, or eye strain or eye twitches, others have a gastro reaction and get stomach aches, reflux, vomiting, nausea, diarrhea, loss of appetite, or overeating. The most common physical manifestations of anxiety are: skin (rashes), headaches, facial twitches, stiff neck, shoulders, or back, stomach/gastro problems, heartbeat irregularities and behavioral problems like increased substance use.

Anxiety that goes on for more than a couple of weeks or is very persistent can affect your health. How do you tell if your health is being affected? First check your stress. There are many ways to do this. There is a Holmes Rahe Stress scale online (and posted on our blog at pinerest.wordpress.com) with questions about common stressors, financial, relationship, work, etc. It gives you a score to let you know if your stressors will likely affect your health.

If you feel stressed, overwhelmed or anxious try taking a break or vacation and see if your health improves. If you are anxious and losing sleep, have lost interest in what you love, feel guilty, have low energy or trouble concentrating, if your appetite is off, and any of these is going on for a couple of weeks or more, it a sign that your anxiety is affecting your health. You need to see a doctor or therapist.

Another great thing to do to control anxiety is meditation. Meditation is a wonderful way to return to your center when you are overwhelmed. Deep breathing and relaxation can be great tools as can spirituality. Church families can often provide hope and reassurance that you are not alone. Don’t forget the power of prayer. Talk to God. He’s the best friend we’ve got. Whatever you do, try not isolating yourself. Isolation is the biggest predictor of depression, and depression is very closely tied to anxiety.

Sometimes anxiety gets the best of you and turns into a panic attack. The Mayo Clinic defines a panic attack as “A sudden episode of intense fear that develops for no apparent reason and that triggers severe physical reactions.” Panic attacks can be very frightening. Panic attacks can occur at any time with no warning.

Physical symptoms can include:
• A sense of impending doom or death
• Rapid heart rate
• Sweating
• Trembling
• Shortness of breath
• Hyperventilation
• Chills
• Hot flashes
• Nausea
• Abdominal cramping
• Chest pain
• Headache
• Dizziness
• Faintness
• Tightness in your throat
• Trouble swallowing

If you experience panic attacks go see your doctor. Panic attacks are hard to manage by yourself and can get worse if untreated. Possibly the scariest thing about a panic attack is the fear of having another one.

If you or someone you know experiences anxiety or panic attacks recognize that they are treatable. The mind is the most powerful part of the human body. That power can convince you something is wrong when it’s not and it can also help you overcome that reaction. It is your biggest tool when dealing with panic and anxiety.

Learning about yourself by becoming aware of the triggers for an anxiety or panic attack then practicing techniques to deal with it before it gets out of control can help you manage attacks. Most people learn – train themselves – to wait it out. This can take 5, 15, 30 or 60 minutes. Remember, it will pass, like a rain storm or fire; it can only go on for so long. Learning what works for you, whether it’s deep breathing exercises or meditation, then practicing those skills when you are not having an attack will help you most successfully manage through an attack. when you do.

Sometimes medical treatment is necessary. There are good short term medications to help relieve anxiety, but you need to be under a doctor’s care. Talking to a therapist can help you identify things that trigger your attacks and why. Pine Rest has a number of therapists at various locations across West Michigan who can help. To find one near you call our Central Access Center Monday – Thursday 8 a.m. – 8 p.m. and Friday 8 a.m. – 5 p.m., and can be reached at (866) 852-4001. They will help identify the right therapist at the right location to meet your needs.

Dr. Carolyn King

http://www.apa.org/topics/anxiety/panic-disorder.aspx

http://www.mayoclinic.com/health/panic-attacks/DS00338

http://www.medicinenet.com/panic_disorder/article.htm

http://www.webmd.com/anxiety-panic/guide/mental-health-panic-disorder

Bullying

For most kids, the fall means a return to school, a return to classes, homework and friends. For too many kids it also means a return to being bullied. According to the American Psychological Association, 40% – 80% of all school age kids are bullied at some point in their school career. Other studies indicate that 10% of kids are bullied regularly. Bullying is serious stuff and can have serious consequences for the victim and the bully.

Bullying is acting in ways that scare or harm another person and is done with intent to intimidate. It is usually done repeatedly. Bullying can be
• physical (hitting, spitting, punching, etc.),
• verbal (teasing, mocking, name calling, etc.),
• social (gossiping, embarrassment, alienation)
• electronic or cyber (using the internet or mobile devices to threaten, hurt, embarrass, etc.)

While bullying occurs across gender lines, boys tend to be more physically aggressive and are more likely to be the bully, and also the target. Girls are more apt to bully indirectly – like spreading embarrassing information. Girls are more likely to be sexually bullied more than boys – receiving sexually explicit messages or having their reputations sullied.

The common denominator is that bullying involves intent to harm and is a source of power and control for the bully.
There are things that we can do to help eliminate bullying:
• Talk to your children everyday. This encourages disclosure.
• Be observant for
– Missing personal items
– Physical complaints hoping to stay home from school
– Changes in eating and sleeping habits
– A drop in grades.
– Unhappiness regarding school or trouble over behavior
– Defensiveness over behavior and attitude.
• Be a role model. Model non-violent behavior and problem solving.
• Be an educator.
– Teach your kids what is and is not acceptable behavior towards other.
– Practice empathy with your kids and teach them how to firmly speak up and say “no” or “stop”.
– Practice confident body language: standing up straight, speaking up, etc.
• Spend time around your kids and their peers when you can. Volunteer at school.
Research shows 67% of bullying happens when adults are not present.
• Listen and be supportive. They need you to be their advocate, their safe place.
Make sure they know that you believe bullying is wrong and not a normal part of growing up.
• Acknowledge your child might be a bully or might be bullied. Ignoring things rarely makes
them go away.

Left unaddressed, bullying can lead to serious physical and mental outcomes. It can cause low self-esteem, depression, anxiety and a host of associated physical problems.

The causes of bullying can indicate some serious issues as well. Bullies are sometimes the victims of abuse or violence. This can often lead to aggressive behavior. A victim will often victimize.

If your child is being bullied or may be a bully, consider consulting a therapist or psychiatrist. Pine Rest has a number of therapists at various locations across West Michigan who can help. To find one near you call our Central Access Center at (866) 852-4001) Monday – Thursday 8 a.m. – 8 p.m. and Friday 8 a.m. – 5 p.m. Our staff will help identify the right therapist at the right location to meet your needs.

Dr. Carolyn King

Bullying –
Other Places To Get Help

American Psychological Association
750 First Street NE
Washington, DC 20002-4242
Phone: 1-800-374-2721
Web Address: www.apa.org

Committee for Children
568 First Avenue South
Suite 600
Seattle, WA 98104
Phone: 1-800-634-4449
Web Address: www.cfchildren.org

KidsHealth for Parents, Children, and Teens 10140 Centurion Parkway North
Jacksonville, FL 32256
Phone: (904) 697-4100
Web Address: www.kidshealth.org

Mental Health America
2000 North Beauregard Street, 6th Floor
Alexandria, VA 22311
Phone: 1-800-969-NMHA (703) 684-7722
Web Address: www.mentalhealthamerica.net

Resources:

http://www.stopbullying.gov/
http://kidshealth.org/teen/your_mind/problems/bullies.html
http://www.aacap.org/cs/root/facts_for_families/bullying
http://www.aacap.org/cs/root/facts_for_families/understanding_violent_behavior_in_children_and_adolescents
http://www.webmd.com/parenting/tc/bullying-topic-overview
http://www.webmd.com/parenting/tc/bullying-topic-overview
http://www.collegiatetimes.com/stories/15450/suicide-rate-increases-in-teens-as-an-effect-of-bullying

Sandwich Generation – The Big Squeeze

Like almost 22 million other Americans, I have 2 sons still at home and a few years ago my mom, who is in her 80’s, came to live with us as well. That’s when I became part of the Sandwich Generation – those of us (largely baby boomers) who are juggling jobs, kids and parents (or other elder relatives) who come to live with us or who need our care remotely, because they are experiencing health issues. We are the generation of caregivers.

The Sandwich Generation faces a unique set of challenges. Due in large part to the advances in health care, people are living longer, often with health concerns that require care-giving. Couple this with the trend in our generation to have our children later in life, and mix in a full time job and people like me are feeling the big squeeze. Juggling kids, parents (whether living with you are at a distance), a spouse and a job is no small feat. It’s no wonder many times care giving leads to needing care for mental and physical health problems.

Care givers are under A LOT of stress. They are twice as likely as others in their demographic to suffer from depression and have a significantly higher risk of experiencing a variety of stress related illnesses – largely because they forget to take care of themselves. The more time demands on you the harder it is to find the time for yourself. Often just thinking about taking time for a bath, a walk or a night out alone with your spouse can cause a lot of guilt. Job pressures and financial strain can create the perfect storm of stress for the care giver. And many times the emotional and mental strain doesn’t end when the sandwich situation does. Grief is very emotional and feelings that you could have done more will prolong feelings of guilt. Similarly, if your kids go off to college you may feel you lost precious time with them and didn’t give them your best.
The good news is there is a lot you can do to lessen the stress. The first and most important thing you can do is surround yourself with a strong support system. Friends, family and your church community can help with eldercare or just listen. Don’t be afraid to lean on your spouse or a friend. It may help them understand what you are going through and prevent problems in you r marriage or other relationships too! Your support network can help in other ways too. And let your employer know what’s going on. Next, stay healthy – eat healthy, exercise, and so on. Don’t drink too much or turn to drugs. Finally, remember God is always there to listen and support you. One of my favorite sayings is “Let go and let God.”

And ask for help if you need it. For instance if you live in Western or Northern Michigan, Pine Rest has staff that specializes in these issues and types of situations. Our Central Access Center Monday – Thursday 8 a.m. – 8 p.m. and Friday 8 a.m. – 5 p.m. can be reached at (866) 852-4001. They will help identify the right therapist at the right location to meet your needs.
It’s important to let the guilt go. Let it go! It’s really important to take time for yourself. Schedule time for you – take a bath, go to a movie (without kids or parents), get your nails done – do whatever relaxes you. Taking care of yourself is the single most important factor in maintain your physical and mental health.

Remember, being in the “Sandwich” isn’t all bad. It’s an opportunity to teach your children about the value of older adults and is a life lesson in selflessness and love. God wants us to treat others as we would have them treat us.

Carolyn King, MD is a child and adult psychiatrist at Pine Rest Christian Mental Health System in Grand Rapids, Michigan. And an Assisstant Clinical Professor MSU School of Medicine.
Dr. King’s clinical experience includes child inpatient and outpatient, as well as adult inpatient and outpatient psychiatry. Dr. King specializes in the treatment of Depression, Anxiety, ADHD, and Developmental Delays across the Life Span.

Dr. Carolyn King

Resources:

http://www.caregiver.com/channels/rural/articles/sandwich_generation.htm
http://marriage.about.com/cs/sandwich/a/sandwichgen.htm
http://abcnews.go.com/GMA/Parenting/story?id=4487229
http://pilgrimmanorgr.posterous.com/tips-for-caregivers-feeling-sandwiched-at-bac
http://money.cnn.com/2007/02/20/magazines/moneymag/tug_of_war.moneymag/
http://www.psychologytoday.com/blog/adventures-in-old-age/200904/caregiver-stress-would-you-some-angst-sandwich-generation
http://www.cbsnews.com/stories/2006/05/08/eveningnews/main1600179.shtml

Click to access art1full.pdf

http://www.squidoo.com/thesandwichgeneration
http://www.strengthforcaring.com/manual/balancing-work-and-family-family/the-sandwich-generation/
http://www.hopetocope.com/item.aspx/744/sandwich-stress

http://www.forbes.com/2007/07/25/geriatrics-medicare-medicaid-pf-retire-in_sm_0725reti

Postpartum Depression – What About the Kids?

Postpartum Depression

The good news is postpartum depression (PPD) is treatable. Those who suffer from it are
not bad parents. They are not monsters who will hurt or damage themselves, their child,
or others. They do have an illness that can be treated. Postpartum and other perinatal
mood disorders (PMD) can have serious consequences when left untreated. These
consequences affect not just the sufferer but those closest to them as well. The littlest yet
most important victims of untreated PMD are the babies.

Research has shown that left untreated, PMD can have serious ramification for the
children of those who suffer from it. Problems in babies and children include behavioral
issues, problems with emotional and social development, cognitive delays, and a greater
risk for lifelong struggles with depression. Some of the research findings include:

• Depression during pregnancy causes problems for the newborn such as
inconsolability, sleep problems, decreased appetite, and less responsiveness with facial expressions.
• Babies with depressed mothers have a high incidence of excessive crying or colic.
• Mothers with PPD report infant sleep and crying problems more frequently than non-depressed mothers.
• Children whose fathers suffers with depression are about twice as likely to have behavioral problems in preschool.
• PPD in the mother is linked to poor cognitive test scores in children which can include learning to walk and talk later than other children the same age, learning difficulties, and problems in school.
• PPD in parents can lead to emotional problems later on for children such as increased anxiety, low self esteem, and less independence.
• Older children in the family may lose part of their childhood due to
emotional detachment from the child as part of the PPD.
• In rare but serious cases, there are instances where a parent commits suicide due to PMD. Children whose parents commit suicide are at greater risk for suicide later in life.

PMD Impacts Children
PMD can and does impact children. The adverse effects can start during pregnancy and
occur for multiple reasons.
Untreated depression and anxiety during pregnancy impact the developing baby as
maternal hormones cross the placenta. These hormones lead to complications after birth
such as fussiness, crying, and inconsolability. In one study, researchers looked at the
brain activity of babies born to depressed mothers. These babies’ brain activity matched
the brain activity of adults diagnosed with major depression.

The effects of untreated PMD continue after birth, changing from biological to
environmental. It is difficult for people struggling with depression (not sleeping, irritable
mood, tearfulness, appetite problems) to care for an infant. Bonding between mother and
baby can be interrupted when the mom is depressed. The mom may have difficulty
responding to the infant’s cues. Babies bond with their mother by giving cues (crying
when wet or hungry, smiling, cooing) and having the cues responded to appropriately
(changing the diaper, feeding, smiling and talking to back). Mothers with PMD may be
withdrawn and at times even feel hostile towards the baby making it difficult to respond
to or many times even recognize cues.

It is important for all parents struggling with PMD to know that it is not their fault.
Please note that it is untreated PMD impacts children. The message for people
struggling with PMD is that there is hope and healing but they need to get help. It is easy
to read all of the negative impacts of PMD on children and feel discouraged. But getting
help not only will allow the parent feel better, but can prevent negative impacts in
children as well.

Here is what you can do if you or a loved one is struggling:
Look for a good support group in your area. See http://www.postpartum.net for a support group
near you. Find a therapist who has been trained in PMD. Let your physician, psychiatrist,
OB/GYN know you are struggling. Remember: this is not your fault and with the right
help you will get better.

For more information:
http://www.helpguide.org/mental/postpartum_depression.htm
http://cjournal.concordia.ca/journalarchives/2006-07/may_24/011126.shtml

In West Michigan
www.PineRest.org
www.momsbloom.org
www.dadsgrow.com
www.healthykent.org

Call 1-866-852-4001 to find the right therapist for you

This article is Part IV in a series.
Click on the individual articles below:
Part I: “What Happens When There is No Joy?”
Part II: “Baby Blues or Something More?”
Part III: “Postpartum Depression – Not Just a Woman’s Illness”

Gretchen Johnson,

Gretchen Johnson, BS, BSN, RN-BC, manages an inpatient unit and
the Adult Partial Hospital program at Pine Rest Christian Mental
Health. She is a member of the Healthy Kent 2020 Perinatal Mood
Disorder Coalition, American Psychiatric Nurses Association, and
the Psychiatric Nursing Council of Southwest Michigan.

Weighing in on Mental Health – from Obesity to Anorexia

Summer is here. Bathing suit season is upon us. Every year this single item of clothing causes stress and self esteem issues and puts a spotlight on the topic of weight. Too fat? Too skinny? What are the causes…and cures?

Many times mental health problems are present along with weight issues. Which comes first the pounds or the problems? Do weight issues cause mental health problems like depression or do mental health problems cause weight issues like anorexia? The short answer is both. You cannot look at one without considering the other and you need to do that absent of bias and stereotypes.

Weight and mental health issues can be intimately connected but aren’t the only factors. Genetics, life style and environmental factors can also play a role. We supersize our meals then sit and play video games. If your parents had depression or other mental health issues you are at higher risk. Stigma surrounding mental health issues like depression and obesity can result in discrimination and unfair bias and stereotyping. Being subjected to that can lead to or contribute to depression and weight issues.

Depression is often related to weight gain and anxiety is often related to weight loss. These two are so interrelated the medical diagnosis is changing to “Anxious Depression” effective in the year 2013. Depression/anxiety can cause weight gain or loss and weight problems can cause depression/anxiety.

The body’s own attempts to feel better can further exacerbate the problem, perpetuating an already vicious cycle. Depression can make a person crave certain foods, like sweets, carbs, and caffeine. It’s the brain’s attempt to make you feel better. This can lead to an increase in weight. Too much weight gain and you are overweight, which can cause a lowering of self esteem. What started out as a good thing – increased appetite to make you feel better- when done in excess can lead to a real obesity problem and more problems with depression. Weight and mental health issue can quickly become a vicious cycle that is hard to break free of.

The other side of the weight-mental health relationship occurs when mental health issues affect weight. Depression can cause weight loss. For instance, suffering the loss of a loved one can cause a loss of appetite translating to weight loss. Another example is Anorexia Nervosa. Anorexia Nervosa is an eating disorder characterized by refusal to maintain a healthy body weight and an obsessive fear of gaining weight. Anorexia Nervosa can lead to starvation and serious health problems like osteoporosis, kidney damage, heart disease and sometimes, death. Anorexia, and all eating disorders are complex, and experts don’t really know what causes them. They may be due to a mix of family history, social factors, and personality traits. Anorexia may start with simple dieting that ultimately results in chronic loss of appetite and a turns into anorexia.

Weight and mental health issues are intimately tied together. In order to have success treating either we must look at the whole person and recognize that the mind is a part of the body, not separate from it. We need to treat the whole person. Some other recommendations include:

• Treat the mental health issue first or at the same time as dealing with the weight issue (unless it is life-threatening of course). Work towards breaking the cycle.
• Pay attention and listen. If someone you love thinks they are too skinny or fat and you look and think “they’re nuts” remember their perception of self is what really matters. They may need professional help to obtain a more realistic perception of self.
• The brain isn’t prejudiced: skinny is as bad for you as fat. Try and let go of your innate biases and stereotypes.
• Exercise really can help the mind as well as the body

Finally, and most importantly, get professional help. Find a therapist or doctor that specializes in the problem and patient.

For those living in the West Michigan area:
Pine Rest will match you up with the doctor or therapist that best meets your needs and situation. Call 1-866-852-4001.

http://www.webmd.com/mental-health/anorexia-nervosa/anorexia-nervosa-topic-overview

http://www.anad.org/get-information/about-eating-disorders/anorexia-nervosa/

http://psychcentral.com/news/2010/09/14/infant-birth-weight-connected-to-mental-illness-risk/18145.html

http://www.psychiatrictimes.com/schizoaffective/content/article/1145628/1470231

http://www.azdhs.gov/bhs/qhi/files/qhi1_4provider.pdf

http://www.ncbi.nlm.nih.gov/pubmed/20919592

http://www.goodtherapy.org/blog/mental-health-weight-self-esteem/

http://www.nimh.nih.gov/health/publications/eating-disorders/complete-index.shtml

http://www.healthyplace.com/eating-disorders/main/eating-disorders-anorexia-nervosa-the-most-deadly-mental-illness/menu-id-58/

http://www.something-fishy.org/isf/mentalhealth.php

http://www.webmd.com/mental-health/anorexia-nervosa/anorexia-nervosa-topic-overview

http://well.blogs.nytimes.com/2010/06/16/exploring-the-links-between-depression-and-weight-gain/

http://www.jahonline.org/article/S1054-139X%2898%2900160-8/abstract

http://kidshealth.org/teen/your_mind/body_image/male_bodyimage.html#cat20125

http://www.pinerest.org/today-magazines

http://kidshealth.org/teen/your_mind/body_image/body_image.html?tracking=T_RelatedArticle#cat20125

http://kidshealth.org/teen/your_mind/body_image/body_image_problem.html#cat20125

Dr. Carolyn King

Traveling with Active Children – Make the Trip a Journey

Not many thoughts inspire terror in the hearts of parents as much as the idea of a long car (or plane or train…) trip with their kids. “Are we there yet?….He/she is touching me!….I have to go to the bathroom……My batteries died….Why does he/she get to sit in the back?….I feel sick” and so on.

Family trips are supposed to be fun, bonding experiences. Family vacations are meant to be relaxing and refreshing, creating great memories for all. Many times though, they start and end on a stressful, unpleasant note, especially if you have very active or hyperactive kids.

Active kids can be described as restless and fidgety. They tend to be more curious and explore more than other kids their age. Hyperactive (ADHD) kids have difficulty concentrating on one active for more than a couple of minutes at a time. Often, hyperactive kids have difficulty learning. All that being said, kids, particularly young ones are active by nature…it’s why ADHD is not typically diagnosed until at least age 5. An estimated 3 to 5 percent of all pre-school and school age children have ADHD. If you suspect your child might have ADHD talk to your family physician. They can refer you to a child psychiatrist who will be able to diagnose and treat ADHD.

Every child is “hyper” sometimes. Some situations even set them up to be so excited. Vacation is certainly one of those times. For kids that are active or hyperactive it escalates their already active behavior. The good news is you can anticipate and plan for these times. You can help everyone enjoy the trip and set the tone for a more enjoyable “ride.”

Most parents have figured out by the time their kids are toddlers that kids do better when they have a routine. Since vacations tend to be times when routines are broken it important to try and maintain as many as possible. Before vacation, establish a travel routine every time you go some where. Perhaps it involves making sure everyone has gone to the bathroom and has their favorite healthy snack, drink and snuggly toy. Seats that are “assigned” become that child’s space and a place for them to store and access toys, games and books.

The day before you travel have them setup and organize that space. Keep to naptimes and meal times as much as possible. Being well rested and eating well make everyone cope better and feel better. Food choices and caffeine are important factors which can increase or decrease the attention span and activity level of a child.

Including your kids in the creation of a travel plan will help them feel ownership and remove some of the anxiety of not knowing when and what is going to happen. Give them a job like time-keeper – the person who watches the clock and indicates when it is time to do something like stop for lunch. Provide an environment where you can say “yes” to them instead of “no”. Instead of “are we there yet?” they know when you expect to arrive and can say “We are two hours away, lets make one more rest stop,” allowing them to play a part in making the when happen.

Make the trip a journey by stopping at fun places along the way. Be sure to build breaks into the plan. Anticipate the eventual bathroom and meal breaks and do a bit of research before hand to find fun places to stop – better yet include your kids in the research and planning. Perhaps there is a national park where you can run and explore or throw a ball around? Maybe it’s stopping to see the world’s largest swing set or the critter barn with the two headed snake. Make the stop a “two-fer,” creating a memory while getting rid of some excess energy. Make the side-trip part of the journey, part of the vacation.

DVD players, handheld electronic games and other electronics are a huge part of this generation’s self-soothing skill set. Headphones can be a particular blessing – providing peace for all occupants! How about a personal set of ear-plugs for everyone to act as a silencer to help reduce or eliminate annoyances? A couple of caveats: don’t depend exclusively on one strategy to make the trip pleasant. A variety of books, games, electronics and snacks will make the trip more enjoyable for everyone. Vacations are meant to stimulate the senses of sight, hearing, smell, taste, touch, temperature, and movement. The trick is to keep the stimulation pleasant, nonthreatening and nontoxic as much of the time as possible. Help the participants think about what makes them most comfortable in terms of their “senses”.

If someone is dependant on electronics for self soothing, have them pack a backup set of batteries, electronic car charger or converter. Old school travel aides like books on tape or listening to the local radio station, and card games can buy 30 minutes to several hours of shared family fun. I will always remember listening to “Because of Winn Dixie” as a book on tape during a road trip to Mississippi, just like I remember the side trip to see the fish that drank out of a baby bottle at the steamship museum in Ohio, and the Natural Bridge on a Virginia side trip, and so on.

Lastly, modeling consideration and hospitality can be a challenge or it can be like a game where Simon says: “Now it’s time to just BE NICE because it’s good for you and me!” This happens instantly when you slow down. Try it: slow down your rate and volume of speaking. Notice how your breathing slows down. As your breathing slows, notice that your heart rate slows. Now slow down your pace of movement. Wow, feeling relaxed? Hmmm, sounds like a nice way to start a vacation. Have fun.

To learn more about the Pine Rest Foundation go to: http://pinerest.org/foundation

Additional information, resources, and links:
http://www.aacap.org/cs/ADHD.ResourceCenter
http://www.aacap.org/cs/root/facts_for_families/children_who_cant_pay_attention/attention_deficit_hyperactivity_disorder
http://www.associatedcontent.com/article/5771362/fun_activities_for_overactive_children.html?cat=25
http://www.education.com/reference/article/Ref_Teaching_Techniques/
http://www.helwys.com/learningmatters/lm_pages/childarchives/chldarchv_tipsforhandling.html
http://www.indiaparenting.com/manners-and-discipline/98_1154/the-overactive-child.html
http://www.parents.com/toddlers-preschoolers/development/behavioral/overactive-or-adhd/
http://www.todaysparent.com/lifeasparent/parenting/article.jsp?content=20100614_115014_6404&page=1

Carolyn King, MD is a child and adult psychiatrist at Pine Rest Christian Mental Health System in Grand Rapids, Michigan.
Dr. King’s clinical experience includes child inpatient and outpatient, as well as adult inpatient and outpatient psychiatry. Dr. King specializes in the treatment of Depression, Anxiety, ADHD, and Developmental Delays across the Life Span.

Dr. Carolyn King