17 Jan 2012

Obsessions and compulsions in children, from the Harvard Mental Health Letter

By Raquel Schott

BOSTON? It is normal for many children, at various stages of development, to be concerned about sameness and symmetry and having things perfect, to insist on certain bedtime routines, or to develop superstitions and rituals like avoiding cracks in the sidewalk. But when such beliefs or behaviors become all-consuming and start interfering with school, home life, or recreational activities, the problem may be obsessive-compulsive disorder (OCD).

"Symptoms may appear as early as age three," notes Dr. Michael Miller, editor in chief of the Harvard Mental Health Letter. "Over the past decade, several randomized controlled trials and literature reviews have concluded that both cognitive behavioral therapy and medication can help youths better manage OCD?but that the combination of both is best. The ideal approach is to try this psychotherapy before turning to medication."

A version of cognitive behavioral therapy known as exposure and response prevention is typically used in treating OCD in patients of any age. During therapy, a clinician gradually exposes patients?either physically or mentally (through the imagination)?to the things, places, and circumstances that provoke obsessions. Eventually, if all goes well, the patient learns to tolerate the anxiety through habituation. In a sense, this detoxifies the stimuli and makes the compulsive behaviors unnecessary.

Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) and sertraline (Zoloft) are the drugs most often used and studied in youths with OCD. SSRIs require two months or more to have an effect on OCD symptoms?a longer time than they usually take to relieve depression. Young people may need to keep taking an SSRI for at least a year and sometimes indefinitely. When the drug is the only treatment, youths usually relapse in a few months if they stop taking it.

Read the full-length article: "Obsessions and compulsions in youths"

Also in this issue:

  • Schizophrenia and epilepsy
  • Recognizing and managing delirium
  • Taming the frenzy in your brain
  • Updated guidelines for treating ADHD
  • Mindfulness training helps people quit smoking
  • Interpersonal therapy

The Harvard Mental Health Letter is available from Harvard Health Publications, the publishing division of Harvard Medical School, for $59 per year. Subscribe at www.health.harvard.edu/mental or by calling 877-649-9457 (toll-free).

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19 Dec 2011

How to get through the holidays while grieving, from the Harvard Mental Health Letter

By Raquel Schott

BOSTON– Each year, more than two million men, women, and children die in the United States, leaving behind loved ones who mourn them. The holidays are often the most difficult time of the year for people who are grieving.

"If the grief is fresh, holiday cheer can seem like an affront and celebrations may underscore how alone people feel," notes Dr. Michael Miller, editor in chief of the Harvard Mental Health Letter. The following strategies, explored in depth in the December 2011 issue, may help people who are grieving to cope with the holidays.

Start a new tradition. During a holiday dinner, place a lighted candle on the dinner table, leave an empty chair, or say a few words of remembrance.

Change the celebration. Go out to dinner instead of planning an elaborate meal at home. Or schedule a trip with friends.

Express your needs. People who are grieving may find it hard to participate in all the festivities or may need to let go of unsatisfying traditions. It's all right to tell people you're just not up to it right now or to change plans at the last minute.

Help someone else. It may also help to volunteer through a charitable or religious organization. Make a donation to a favorite cause in memory of the person who died.

Give yourself time. The grieving process doesn't neatly conclude at the six-month or one-year mark. Depending on the strength of the bond that was broken, grief can be life-long. Nevertheless, grief does usually soften and change over time. With time, the holidays will become easier to handle.

Read the full-length article: "Handling holidays and difficult times"

Also in this issue:

  • The normal process of grieving
  • Beyond the five stages of grief
  • How people can help themselves while grieving
  • Coping with complicated grief
  • How long does grief last?

The Harvard Mental Health Letter is available from Harvard Health Publications, the publishing division of Harvard Medical School, for $59 per year. Subscribe at www.health.harvard.edu/mental or by calling 877-649-9457 (toll-free).

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31 Jan 2011

Exercise counteracts anxiety and depression, from Harvard Men's Health Watch

By Raquel Schott

Exercise counteracts anxiety and depression, from Harvard Men's Health Watch

BOSTON–Regular aerobic exercise can bring remarkable changes not just to your body your metabolism, and your heart, but also to your spirits, reports the February 2011 issue of Harvard Men's Health Watch.

Aerobic exercise is the key for your head, just as it is for your heart. It has a unique capacity to exhilarate and relax, to provide stimulation and calm, to counter depression and dissipate stress. Endurance athletes commonly experience the restorative power of exercise, and this has been verified in clinical trials that have used exercise to treat anxiety and depression.

How can exercise contend with problems as difficult as anxiety and depression? There are several explanations, some chemical, others behavioral. The mental benefits of aerobic exercise have a neurochemical basis. Exercise reduces levels of the body's stress hormones, such as adrenaline and cortisol. It also stimulates the production of endorphins, the body's natural painkillers and mood elevators.

Behavioral factors contribute to the emotional benefits of exercise. As your waistline shrinks and your strength and stamina increase, your self-image will improve. You'll earn a sense of pride and self-confidence. Your renewed vigor will help you succeed in many tasks, and the discipline will help you achieve other lifestyle goals. Exercise and sports also provide opportunities to enjoy some solitude or to make friends and build networks.

Harvard Men's Health Watch notes thatyou should exercise nearly every day. That doesn't necessarily mean hitting the gym. But it does mean at least 30 minutes of moderate activity. And if you need more help with stress, consider autoregulation exercises involving deep breathing or muscle relaxation.

Read the full-length article: "Exercising to relax"

Also in this issue:

  • Meat or beans–which is the better protein?
  • Heart disease and testosterone replacement
  • Ultrasound checks for abdominal aortic aneurysm

Harvard Men's Health Watch is available from Harvard Health Publications (www.health.harvard.edu), the publishing division of Harvard Medical School, for $28 per year. Subscribe at www.health.harvard.edu/men or by calling 877-649-9457 (toll-free).

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11 Oct 2010

Protecting teens from overexposure to violent video games, from the Harvard Mental Health Letter

By Raquel Schott

BOSTON?American homes are increasingly besieged by menacing zombies, invading aliens, and threatening criminals. The fact that these beings exist only on-screen?as characters in popular video games?may be small comfort to parents concerned about limiting their children's exposure to violence. The October issue of the Harvard Mental Health Letter reports that worries about video game violence are probably overblown, but also offers advice on how parents can minimize any potential harm.

As a first step, check a video game's Entertainment Software Rating Board (ESRB) rating to better understand what type of content the game has. It may also help to place video consoles and computers in common areas of the home, such as the kitchen or living room, rather than in children's bedrooms. Finally, set limits on the amount of time youths play these games. The American Academy of Pediatrics recommends two hours or less of total screen time per day?a limit that includes television and computers as well as video games.

Dr. Michael Miller, editor in chief of the Harvard Mental Health Letter, points out that video games share much in common with other pursuits that are enjoyable and rewarding, but that can become hazardous in certain contexts. Parents can best protect their children by remaining engaged with them and providing limits and guidance as necessary.

Read the full-length article: "Violent video games and young people"

Also in this issue:

  • Cognitive enhancement therapy for schizophrenia
  • Managing dental phobia
  • Treatment for adolescent depression
  • Living with bipolar disorder
  • Why eating slowly makes people feel full
  • Antidepressants and cataracts

The Harvard Mental Health Letter is available from Harvard Health Publications (www.health.harvard.edu), the publishing division of Harvard Medical School, for $59 per year. Subscribe at www.health.harvard.edu/mental or by calling 877-649-9457 (toll-free).

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16 Aug 2010

Knowing when grief needs treatment, from Harvard Medical School

By Raquel Schott

BOSTON?It's normal for to the death of a close friend or family member to bring sadness, mood changes, or trouble sleeping and eating. For some people, though, grief and bereavement can evolve into clinical depression, according to Coping with Grief & Loss: A guide to healing, a newly updated report from Harvard Health Publications.

While most people pass through grief or bereavement without professional help, it's important to seek a helping hand if troubling or long-lasting symptoms of depression begin to interfere with daily life. Talk with your doctor or a mental health professional if you have suicidal thoughts or experience any of these other symptoms of bereavement-related depression:

  • persistent feelings of worthlessness, which is generally felt with depression but not with healthy grief
  • ongoing guilt
  • marked mental and physical sluggishness
  • persistent trouble functioning
  • hallucinations, other than occasionally thinking you hear or see the deceased.

Small studies suggest that psychotherapy, antidepressant medication, or both may ease symptoms of depression associated with grief.

Sometimes people feel so mired in grief that months or even years go by with little or no let-up. This may be a sign of complicated grief, a term mental health professionals use when grieving proves especially difficult. Complicated grief combines features of depression with those of post-traumatic stress disorder. Among adults who suffer a significant loss, about one in 11 experiences complicated grief. Symptoms include

  • intrusive, upsetting memories, thoughts, and images of the deceased
  • constant, painful yearning for the deceased
  • an inability to accept the reality of the death
  • frequent nightmares
  • detachment from others
  • desperate loneliness and helplessness, anger, and bitterness
  • thoughts of suicide and wanting to die.

Other reasons to seek professional help include drug abuse, increased use of tobacco or alcohol, gaining or losing a significant amount of weight, experiencing uncontrollable anxiety, and failing to feel somewhat better after a year has passed. Talk to your doctor or a mental health professional if you think you may have complicated grief or depression related to grief or bereavement.

This updated Special Health Report also covers these topics:

  • The health effects of grief
  • A guide to grieving at different stages in life
  • Practical coping strategies

Coping with Grief & Loss is available for $18 from Harvard Health Publications (www.health.harvard.edu), the publishing division of Harvard Medical School. Order it online at www.health.harvard.edu/GLor by calling 877-649-9457 (toll-free).

06 Jul 2010

Spending time outdoors is good for you

By Raquel Schott

Spending time outdoors is good for you, from the Harvard Health Letter

BOSTON?Summer is here. The outdoors beckons. Heed that call and you'll reap physical and mental health benefits, reports the July 2010 issue of the Harvard Health Letter. Here are five good reasons to get outdoors:

Your vitamin D levels rise. Sunlight hitting the skin begins a process that leads to the creation and activation of vitamin D. Studies suggest that this vitamin helps fight certain conditions, from osteoporosis and cancer to depression and heart attacks. Limited sun exposure (don't overdo it), supplemented with vitamin D pills if necessary, is a good regimen.

You'll get more exercise. If you make getting outside a goal, that should mean less time in front of the television and computer and more time walking and doing other things that put the body in motion.

You'll be happier. Light tends to elevate people's mood, and there's usually more light available outside than in. Physical activity has been shown to help people relax and cheer up, so if being outside replaces inactive pursuits with active ones, it might also mean more smiles.

Your concentration will improve. Children with ADHD seem to focus better after being outdoors. It might be a stretch to say that applies to adults, but if you have trouble concentrating, outdoor activity may help.

You may heal faster. In one study, people recovering from spinal surgery experienced less pain and stress and took fewer pain medications when they were exposed to natural light. An older study showed that the view out the window (trees vs. a brick wall) helped recovery in the hospital.

Read the full-length article: "A prescription for better health?go alfresco"

Also in this issue:

  • Aspirin and cancer prevention

  • Peripheral neuropathy treatment

  • Niacin for boosting "good" HDL cholesterol

  • Safety of using ibuprofen p.m. as a sleep aid

  • Omega 3s and nutrition

The Harvard Health Letter is available from Harvard Health Publications (www.health.harvard.edu), the publishing division of Harvard Medical School, for $29 per year. Subscribe at www.health.harvard.edu/health or by calling 877-649-9457 (toll-free).

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