V O L U M E V I S S U E I I D B S A S o u t h e r n N e v a d a S P R I N G E D I T I O N
WH W A H T A T C A C N A N D B D S B A S A S O S U O T U H T E H RN R N N E N V E A V D A A D A SU S P U P P O P R O T R T G R G O R U O P U S P S D O D O F O F R R Y O Y U O ? U ? “A “A F A F M A I M L I Y L Y M E M M E B M E B R E S R S E XP X E P R E I R E I N E C N E C ” ” SUB U M B I M T I TE T D E B Y P AR A E R N E T N R OB O I B N I M . M
first week. It turns out the Zoloft security, and attacked sev-
INSIDE THIS ISSUE
For eight hours, I sat beside my 12 year
olds body, holding her hand, listening to
not tell me if she’d see daylight. The
with schizophrenia, the rest of the girls
were hard core, and I’m afraid my little
a local private psychiatric hospital that
girl got quite the street-wise education.
needed. I would have had the support for
situations. She was finally placed in De-
myself, so that I would not have reached
she will spend eight months in this state
the tools—education, the materials, the
week in the psychiatric facility—again,
people, and the contacts—to help my lit-
It’s been a long, depressing disaster that
vember for having a knife at school (she
has taken its toll on all of us. My parents it’s achieved a higher level of happiness
“forgot” it was in her purse, lost the
purse and they found it looking for ID—
more sad, was that she had crept into the
hospitalization occurred. I can hear the
room and see other’s nodding their head
they wonder if this call will bring good
words out, is a grateful and bonding feel-
but also my ability to assist my daughter
ing I just can’t explain. I’ve felt the
loneliness, the fear, the helplessness; I’ve
cried alone, shouldered the burden alone.
ing until late Jan to resolve—the whole
bipolar disorder. The interpersonal rela-
ing, and strained by the emotional roller
coaster ride as they go from manic event
Then they put her in a detention school.
action from January to May is in calcula-
tionally, although scholastically she ex-
ble—I will never know if, had they taken sues, court hearings, answering the
phones 24 hours a day. They are there to
My hope for my daughter is she finds the
placement in a residential treatment cen-
ter specifying that). However, the state
facility she did qualify for was full. As
her first child. This article was written in
the group before this time, I would have
MONDAY EVENING WEDSDAY EVENING THURSDAY EVENING ADOLESCENT DIAGNOSED DUAL DIAGNOSED ADULT DIAGNOSED Ages 13-17 Addiction and Mood Disorder (18 & OVER) 6:30 PM TO 8:00 PM 6:00 PM TO 7:30 PM 6:00 PM TO 7:30 PM Rawson-Neal Psychiatric Rawson-Neal Psychiatric Hospital Hospital Rawson-Neal Psychiatric Hospital 1650 Community College 1650 Community College 1650 Community College Drive Las Vegas, NV 89146 Las Vegas, NV 89146 Las Vegas, NV 89146 Training Room 1 Training Room 1 Training Room 1 MONDAY EVENING WEDSDAY EVENING THURSDAY EVENING PARENTS OF DIAGNOSED PARENTS, FAMILY & ADOLESCENTS FRIENDS Post Traumatic Stress Disorder 6:30 PM TO 8:00 PM 6:00 PM TO 7:30 PM 6:00 PM TO 7:30 PM Rawson-Neal Psychiatric Rawson-Neal Psychiatric Rawson-Neal Psychiatric Hospital Hospital Hospital 1650 Community College 1650 Community College 1650 Community College Las Vegas, NV 89146 Las Vegas, NV 89146 Las Vegas, NV 89146 Training Room 2 Training Room 2 Training Room 2 CONSUMERS CORNER The Road To Recovery By Arnold Wax MD
When I arrived at the facility in Houston, I Now, I have found my own place to live
was met by and interviewed by a resident
rather than bore everyone with that much
versity. We talked for well over an hour
detail, I will tell my path from last year to
about what I hoped to gain for the future. I It works for me and I tolerate it well. I
then was taken to the unit I was to be on.
It was known as the PIC (Professionals in
even giving it a second thought. You see
tempt. The attempt had been planned over signed a primary nurse and a mental health they work for me when I work on them. a 6 week period of time and it was times so coordinator and a “buddy” to show me
around the unit and the facility. He was
weeks at this facility where I had an indi-
story. She didn’t even bat an eye. Her
fail and that I would die. I had no fear of
vidual therapist, two psychiatrists (an at-
comment was “you seem healthy to me.”
dying, only the fear of living. The reason
tending and the resident) and a “primary
So you see, there is a road to recovery.
factors, a broken marriage, at my doing, a
Everyone is capable of recovery, it is a
broken subsequent relationship, a failing
personal choice. It’s not a cure just like
practice and mounting debts with no fore-
seeable way of satisfying the depts. I was
so horribly depressed, in despair, lonely
siliency, positive psychology, cognitive
support systems ( and I gave a great one
and alone as well as isolated that I felt I
behavioral therapy and dialectic behavioral stretching from California to England)
therapy as well s family therapy and voca-
only time I didn’t face these problems was tional therapy groups. This was the step-
my chagrin I didn’t die, at least not then.
After 9 weeks at the facility I was ready to that.
go home. Prior to leaving I completed, as
The next morning, my daughter called and required, a rather intensive wellness plan
invited me over for dinner, but I said I
describing my short and long term future
goals. I arranged to see a psychiatrist, a
She called again later as did her sister and
psychotherapist and my regular physician
heads up our facilitator training program.
and dentist for follow-up. You see part of
had taken. I told them to leave me alone,
recovery from a mental illness is to keep
ones self well physically. I also arranged
lance, came to my home, broke in the back to see a physician to after my thyroid gland our readers, and wish him continued suc-door and over my protests I was taken a
something for which I ultimately had sur-
hospital. I spent a month in the hospital as gery.
I suffered a perforated ulcer and had to
Lastly, I found support groups sponsored
piratory failure due to pneumonia. I could by DBSA Southern Nevada and NAMI
have and probably should have died those
DID YOU KNOW? DBSA Southern Nevada sponsors a free monthly community lecture
Once I got out of the acute care hospital, I
tinued on a steady pace. I go to support
series? Check out our website for
was put on a mandatory legal 2000 hold as group meetings weekly, therapies and I
scheduled dates, time, location and
required by law due to my suicide attempt. take care of myself. I am now back at
name of presenter.
work and although it is part time I continue
www.dbsa-southernevada.org
during this time my daughter had found a
to look to increase my work hours as I am
and ultimately did. She arranged for me to pies have been decreased by half. I have
have a bed there and I left Las Vegas for
not had any crises although there have been some difficult times both at work and
PARENT’S OF CHILDREN AND ADOLESCENTS CORNER
PSYCHIATRIC MEDICA- CHILD AND ADOLESCENT TION FOR CHILDREN AND DRUG ABUSE STATISTICS ADOLESCENTS: WHAT TO ASK YOUR DOCTORS
as part of their chil’s treatment plan.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RISK TAKING BEHAVIOR
increases the likelihood of injury or death.
DID YOU KNOW ? ual abuse and rape.
• Verbal abuse, threats, and tem- per outbursts by children diag- Nevada is second in the national
• Neighborhood Care Centers in nosed have been reported by for adolescent suicides? Las Vegas treat Severally Emo- more than 50% of relatives? tionally Disturbed children with- out insurance?
• Adolescents with a Mood Disor-
• A sign of suicidal ideology is giv- der are more vulnerable to bul- ing away personal belongings? lying incidents?
• Adolescents with a Mood Disor- der have serious problems hav-
• Adolescents with a Mood Disor- ing healthy personal relation-
• Adolescents with a Mood Disor- der tend to take more risks than ships and feel very isolated and der are more vulnerable to sex- those not diagnosed? YOUTH RISK BEHAVIOR YOUTH RISK BEHAVIOR TEEN DEPRESSION SURVEILLANCE (CDC) SURVEILLANCE (CDC) SIGNS AND SYMPTOMS UNITED STATES, 2007 NEVADA 2007 TIPS FOR PARENTS Sadness and Suicide Ideation Sadness and Suicide Ideation Symptoms and Attempts and Attempts Teenagers face a host of pres- Felt Sad or Hopeless Felt Sad or Hopeless sures, from the changes of pu- berty to questions about who they are and where they fit in. The During the 12 months preceding
♦ During the 12 months preceding natural transition from child to the survey, 28.5% of students na- the survey, 26.1% of Nevada high adult can also bring parental con- tionwide had felt so sad or hopeless school students had felt so sad or flict as teens start to assert their almost every day for more than 2 hopeless almost every day for independence. With all this weeks in a row that they stopped more than 2 weeks in a row that drama, it isn’t always easy to dif- doing some usual activities. Over- they stopped doing some usual ac- ferentiate between depression and all, the prevalence of having felt sad tivities. normal teenage moodiness. Mak- or hopeless almost every day for ing things even more complicated, more than 2 weeks was higher teens with depression do not nec- among female (35.8% than male Seriously Considered Attempt- essarily appear sad, nor do they (21.2^%) students. ing Suicide always withdraw from others. For some depressed teens, symp- Seriously Considered Attempting
♦ During the 12 months preceding toms of irritability, aggression, the survey, 14.3% of Nevada high and rage are more prominent. school students had seriously con- During the 12 months preceding sidered attempting suicide. the survey, 14.5% of students has Sadness or hopelessness considered attempting suicide. Irritability, anger, or hostility Overall, the prevalence of having Made A Suicide Plan Tearfulness or frequent cry- considered attempting suicide was higher among female (18.7%) than
♦ During the 12 months preceding Withdrawal from friends and male (10.3&). the survey, 14.2% of Nevada high school students had made a spe- Isolating in room Made a Suicide Plan cific plan to attempt suicide. Loss of interest in activities Changes in eating and sleep- ing habits During the 12 months preceding Restlessness and agitation the survey, 11.3% of students na- Attempted Suicide tionwide had made a specific plan Feelings of worthlessness and to attempt suicide. Overall, the Statewide, 8.9% of Nevada high prevalence of having made a spe- Lack of enthusiasm and moti- school students had actually at- cific suicide plan was higher among tempted suicide one or more times female (13.4% than male (9.2%). Fatigue or lack of energy during the 12 months preceding the survey. Difficulty concentrating Attempted Suicide Thoughts of death or suicide
♦ Nevada ranks second in the nation Risk taking more than usual Problems in school. Nationwide, 6.9% of students had with the most completed suicides by adolescents. Listening to sad or music actually attempted suicide one or about death more times during the 12 months Frequents web sites that talk preceding the survey. Overall, the about death prevalence of having attempted sui- Information provided by the Nevada Unexplained aches and pains cide was higher among female Office of Suicide Prevention. (9.3%) than male (4.6%) students. Extreme sensitivity to criti- cism TEEN DEPRESSION TIPS FOR PARENTS SUPPORTING A TEEN SIGNS –CONTINUED THROUGH TREATMENT FROM PAGE –6- Tips For Talking To A As your depressed teenager in your life goes through treatment, the most im- Depressed Teen: SIGNS CONTINUED portant thing you can do is to let him/ her know that you’re there to listen and
♦ Offer Support—Let them know that offer support. Now more than ever, Talking or joking about you’re there for them, fully and un- your teenager needs to know that he/ committing suicide conditionally. she is valued, accepted, cared for and Withdrawing from some, but
♦ Be gentle but persistent Don’t loved unconditionally. not all people. give up talking to your teen if he/she Saying things like, “I’d be shuts you out at first. Be respectful SUPPORTING YOURSELF better off dead,” “I wish I of your child’s comfort level while could disappear forever,” or THROUGH TREATMENT still emphasizing your concern and “There’s no way out.” willingness to listen. Speaking positively about
♦ TAKE CARE OF SELF - In
♦ Listen without lecturing Resist death or romanticizing dying order to help your teen, don’t any urge to criticize or pass judg- (“If I died, people might love ignore your own needs. Eat ment once your teenager begins to me more”). right, get enough sleep talk. The important thing is that Writing stories and poems personal time. your child is communicating. Avoid about death, dying, or sui-
♦ REACH OUT FOR SUPPORT offering unsolicited advice or ulti- Get the emotional support you matums as well. Engaging in reckless behav- need. Reach out to friends, join a
♦ Validate Feelings Don’t try to ior or having a lot of acci- support group, or see a therapist of talk teens out of their depression, dents resulting in injury, or your own. It’s okay to feel over- even if their feelings or concerns ap- an increase in speeding tick- whelmed, frustrated, helpless, or pear silly or irrational to you. Sim- ets or driving infractions. angry. The important thing is to ply acknowledge the pain and sad- Giving away prized posses- talk about how your teen’s depres- ness they are feeling. If you don’t, sion is affecting you, rather than they will feel like you don’t take Saying goodbye to friends bottling up your emotions. their emotions seriously. and family as if for good BE OPEN WITH FAMILYAND Seeking out weapons, pills, FRIENDS Don’t tiptoe around the or other ways to kill them- issue of teen depression in an at- WHAT PARENTS NEED TO tempt to “protect” other family members. Be open about what is Seek Help Immediately if you going on and invite your children, think your adolescent might be family members and friends to ask
• VISIT YOUR FAMILY DR. considering suicide. questions and share their feelings. Make an immediate appointment REMBER THE SIBLINGS De- for your teen to see the family physi- pression in one child can cause National Suicide Hotline cian for a depression screening. stress or anxiety in siblings. Make 1-800-784-2433 SEEK OUT A SPECIALIST sure “healthy” children are not ig- If there are no health problems that nored, they too might need individ- are causing your teenager’s depres- Untreated Depression can ual counseling to deal with their sion, ask your doctor to refer you to feelings. a psychologist or psychiatrist who
♦ AVOID THE BLAME GAME It specializes in children and adoles- can be easy to blame yourself or Problems at school another family member for your Running Away
• EXPLORE TREATMENT teen’s depression, but that only
♦ Substance abuse OPTIONS. Discuss with the spe- adds to an already stressful situa-
♦ Low self-esteem cialist about treatment possibilities. tion. Depression is caused by a
♦ Eating disorders There are a number of treatment number of factors, so it is unlikely,
♦ Internet addiction options, including medication, one- except in the case of abuse, neglect
♦ Self-injury on-one talk therapy, group or family or other trauma that any loved one
♦ Reckless behavior therapy and the possibility of a is “responsible”.
♦ Violence short term hospitalization program.
♦ Suicide
• Research shows that early identification
and intervention can minimize the long term disability of mental disorders.
• Mental disorders in children and ado-
lescents are real and can be effectively
Disclosure Restrictions
• Early identification and treatment pre-
vents the loss of critical developmental
• Early and effective mental health treat-
DID YOU KNOW ?
• diagnosed have been reported Neighborhood Care Centers in Las Ve- by more than 50% of rela- Nevada is second in the national gas treat Severally Emotionally Dis- turbed children without insurance? for adolescent suicides? A sign of suicidal ideology is Adolescents with a Mood Disorder have Adolescents with a Mood Disor- giving away personal belong- serious problems having healthy per- der are more vulnerable to bul- sonal relationships and feel very isolated lying incidents? and alone.
• Adolescents with a Mood Dis- Adolescents with a Mood Disor-
• Verbal abuse, threats, and temper out- der are more vulnerable to sex- order tend to take more risks bursts by children diagnosed have been ual abuse and rape. than those not diagnosed?
UNDERSTANDING AND NAVIGATING THE HIPPAA PRIVACY RULE
Disclosure
a personal rep if the person with mental
illness objects to the disclosure and the
An individual has the right to review and
disclosure is permitted but not required
entities must provide PHI to the individ-
get regarding their relative’s diagnosis,
ual who is the subject of the medical re-
Restrictions
lines some creative legal ways to get needed information.
There are a few exceptions to this rule.
Minor’s Parent/Guardian Disclosure
An individual does not have the right to
What does HIPAA stand for ?
In, most situations, parents/guardians are
access medical records on behalf of their
children. Even in situations where a par-
individual access to their own records if
minor child’s treatment due to an emer-
gency, a health care provider is able to
in which individually identifiable health
Also, some state laws limit the rights of
mentally ill individuals to act on their
Restrictions
In several situations, parents/guardians
Disclosure to a Personal Representa-
closure of PHI by “covered entities.” It
state law does not require the consent of
the parent/guardian before the minor can
the parent/guardian agrees to a confiden-
person with a mental illness. Health care
providers are required to treat personal
treating health care provider. In all these
representatives the same as they treat the
situations, the parent/guardian does not
Covered Entities Include:
patient. This means, that personal repre-
control the minor’s health care decisions, or the minor’s PHL.
sentatives are entitled to full access to
Formal Authorization Restrictions
A covered entity must obtain the written
cian suspects the personal representative
illness for any use or disclosure of PHI
of abusing or neglecting the person with
a mental illness. Disclosure is also lim-
ited when a personal representative only
has authority to act on behalf of the per-
mission constitutes the authorization for
son in limited or specific health care de-
disclosure. It must be written in specific
cisions. In this situation, the personal
terms and state what information is to be
used or disclosed, specify the person dis-
relevant to their area of authority. Also, a covered entity may refuse to share PHI
specify the purpose of the disclosure and
One Technology Drive, Tolland, CT 06084-3900 USA | +1.860.872.7000 | info@nerac.com | www.nerac.com Eisai v. Dr. Reddy The first application of the new KSR obviousness standard in a pharmaceutical context By Michael Fuller, J.D., Reg. Patent Atty. Nerac Analyst Patent practitioners anxiously awaited the Supreme Court’s ruling in KSR International Co . v . Teleflex Inc
International Journal of Neuropsychopharmacology (2005), 8, 457–472. Copyright f 2005 CINPdoi :10.1017/S146114570500516XA meta-analysis of neuropsychological changeto clozapine, olanzapine, quetiapine, andNeil D. Woodward1, Scot E. Purdon2, Herbert Y. Meltzer3 and David H. Zald11 Department of Psychology, Vanderbilt University, Nashville, TN, USA2 Department of Psychiatry, University of Al