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Jun 19, 2013 / 5:00 am
Pretty much all of us know at least one person who seems to have an inflated opinion of him or her self. When talking in the office or sitting down to a meal, the conversation inevitably turns to that person’s accomplishments or martyr-like personality. Maybe the person also highlights angry feelings toward the less competent people who are easy to find everywhere. This person seems to be hyper-critical of everyone except him or herself. Spending time together can be a bore and sometimes a downright painful experience.
It may be that a person like this has narcissistic personality disorder – defined as a pervasive pattern of grandiosity, a need for admiration, a lack of empathy and a tendency to exploit others. This is one of the least studied personality disorders, but the studies that have been done in recent years have uncovered some surprising information about its prevalence and characteristics.
One study interviewed more than 35,000 American adults and was published in the Journal of Clinical Psychiatry. Major findings of this study show narcissistic personality disorder affects roughly six percent of the adult population. Not only is this more prevalent than once thought, but the study also found the condition is much more common among men (eight percent vs. five percent of women). Narcissism also affects younger adults more often than older ones, suggesting the disorder is not as chronic as once believed.
Another study published in the American Journal of Psychiatry, added depth to our knowledge of narcissistic personality disorder and its traits. In this study, data came from clinical observations by psychiatrists and psychologists rather than from patients themselves.
Researchers identified five key features of the condition which include: an expectance of preferential treatment; participation in power struggles; an exaggerated sense of self-importance; criticism of others; and feelings of anger and hostility toward others.
Other features, which were considered common but not necessarily characteristic of the average person with narcissistic personality disorder, included treating others as an audience and a belief that he or she can only be appreciated by those who have high status.
In addition, the study identified three subtypes for narcissistic personality disorder. High functioning exhibitionists have an exaggerated sense of self-importance but are also articulate, energetic, outgoing and achievement oriented. Fragile narcissists want to feel important and privileged in order to hide feelings of inadequacy and loneliness. Finally, grandiose or malignant narcissists not only have an exaggerated sense of self-importance, but exploit others and lust after power.
Although all of these provide valuable insights into the nature of this personality disorder, there is still much research to be done.
To date there is no standard treatment for narcissistic personality disorders. Although some success can be found in treating co-existing problems such as depression, it is very difficult to directly address the personality disorder without alienating the patient.
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Jun 12, 2013 / 5:00 am
A couple of my past columns have dealt with post-partum depression and the importance for both mother and child of treating it appropriately.
Not only does it help mom cope with the transition to having a new child at home, but it can be critical to the bonding process and early relationship of mother and baby – which can have a lasting impact on a developing brain.
Studies have shown that treating the depression of mothers who are no longer post-partum is also beneficial to the mental health of both woman and child.
One study published a couple of years ago in the American Journal of Psychiatry, examined 123 mother-child pairs and found successful treatment of maternal depression improved the mental health of children as well.
Children involved in this study ranged in age from seven to 17 and were assessed every three months for one year after their mothers had already begun a treatment study.
Children were not treated during the study, but doctors were looking for mood, anxiety and disruptive behaviour disorders and did provide information about psychiatric treatment to parents if a disorder was diagnosed.
Results showed a significant decrease in psychiatric symptoms among the children of depressed mothers once the mother’s depression was treated successfully.
Of the 123 mothers being treated for depression, 70 experienced full remission of symptoms and there was a significant decrease in the number of symptoms reported among children whose mothers were in this group. Children of mothers whose depression did not go into remission did not experience a significant change in their symptoms during the one year study period.
Interestingly, the most dramatic decrease in children’s psychiatric symptoms occurred in those whose mothers experienced remission within three months of initial treatment. Symptom improvement was not significant for children of mothers who took longer to get better.
Also, there was no significant association between a child’s symptoms and the current severity of the maternal depression – meaning the mother’s improvement was not likely a result of improvement in the children’s mental health.
Researchers believe these results suggest doctors who are treating children with psychiatric disorders may be wise to ask after the mental health of parents since treating a parent’s mental illness could be beneficial to the recovery of the child.
More research in this area is needed with some additional factors taken into consideration such as whether or not the same effects would occur if depressed fathers received treatment.
Still, these results do provide one more compelling reason to seek treatment for depression. Symptoms do have an effect on your loved ones – both in the way you interact, and (in the case of children) in their own mental health. Seeking help could be beneficial for you and your family.
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Jun 5, 2013 / 5:00 am
Studies have shown that people experiencing serious mental illness are more likely to die as a result of untreated physical health problems than suicide or other mental health complications.
According to one American study, mental health patients in the US are dying 25 to 30 years earlier than other Americans, which is an increased gap from the 10 to 15 year difference that existed in the early 1990s.
Researchers in this study believe misperceptions about health care needs are part of the reason for this increasing gap in mortality.
Some of the most common causes of death among this population were complications from untreated or under-treated conditions such as metabolic disorders, cardiovascular disease and diabetes.
Increased incidence of obesity and smoking are also common – people with serious mental illness smoke 44 per cent of the cigarettes sold in the US.
Unfortunately, people with mental illness also tend to have a harder time accessing health care for a variety of reasons – not least of which is the stigma they continue to face even from medical professionals.
Although the above statistics are from a US-based study, a similar story exists within our own country. A 2007 study published in the Canadian Medical Association Journal found psychiatric status affects survival and access to medical procedures even within a universal health care system.
One major barrier to general medical treatment for the mentally ill is a growing unwillingness of physicians to deal with the complexities they feel might be involved. It is becoming increasingly common even here in Canada for a GP to request an interview and references when considering new patients.
Due to shortages and lack of time, some doctors are hesitant to accept patients if they come with time consuming or seemingly inconvenient problems such as chronic mental illness.
I personally have had patients request reference letters to assure GPs I will continue treating psychiatric issues and that the individual is reliable and willing to work with a doctor.
Advocates believe in order to prevent this increased mortality for those with mental illness, primary care and mental health professionals need to take equal responsibility in caring for these patients.
Not only should physical and mental health care be better integrated through closer communication between health care providers, but individuals themselves need to be educated on how to manage their illnesses – both mental and physical.
Studies have found improvements when nurse case managers have worked to coordinate both mental and physical care for patients - with care including ongoing patient education and communication.
As always, we need to move beyond stereotypes when dealing with mental illness. In spite of a psychiatric condition, other areas of health should not be neglected. People are never one-dimensional and should receive equal consideration regardless of mental health status.
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May 29, 2013 / 5:00 am
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In several past articles I have talked about our increasing knowledge of human genetics as a key to the future of psychiatric treatment.
As we gain understanding, we learn we could potentially analyze a person’s individual genetic make up and then prescribe a corresponding therapy suited to that gene type to relieve symptoms and avoid undesirable side effects.
One brought us one step closer to this goal as it examined the effects of gene variations on response to depression treatment with an SSRI medication.
This study took genetic information from roughly 1,500 white, Hispanic and black Americans who took part in a depression treatment study between 2001 and 2006.
Researchers found that variations in the DNA that regulates the expression of a serotonin transporter gene can influence how patients with depression will respond to drug therapy.
In this particular study, subjects had been treated with SSRI medication citalopram and the genetic analysis showed remission of symptoms was significantly associated with a couple of specific genetic variations.
Not only were two variations found to be associated with better treatment results, but a certain combination of genes led to the worst outcomes – suggesting that physicians could best predict a person’s treatment outcome based on an analysis of several key genes.
Much more research in this area is still needed, but these findings represent a few more pieces in the puzzle to understand the interactions between our genes, depression and treatment response.
This sort of research is gaining momentum and will hopefully begin to inform treatment in clinical settings sometime in the next few years. It is now common practice to do some sort of genetic analysis in most clinical trials.
The majority of clinical trials I am involved with request an extra vial of blood from study volunteers (with their permission) to be used for future analysis to learn if there are genetic markers for response or side effects to the drug being studied.
We are looking forward to the day when we no longer have to rely on simple trial and error when selecting a medication to treat a psychiatric illness. Instead, we will be able to take a blood sample and find out from genetic analysis which drug is most likely to be effective while causing the least risk of side effects for each individual we treat.
This study is simply one more confirmation that genetic research is leading us in the direction of more tailor made treatments for depression and other illnesses.