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Your Mental Health

Cannabis and driving

After many senseless deaths and serious injuries as a result of alcohol impaired driving, Canada has implemented strict laws prohibiting driving under the influence of even a relatively small amount of alcohol.

In BC, it is well publicized that a blood alcohol content of even 0.05 could result in the loss of your license as well as some pretty stiff fines. Hardly anyone protests these laws because they are in place to protect the public from a real danger. Since the penalties have been implemented, alcohol related crashes have dropped significantly.

Although not as common, drug impaired driving has also gained attention. In many places, drugged driving laws are being implemented. Although some of these enforce a zero tolerance policy, others are setting legal limits as in the case of alcohol.

Marijuana is by far the most widely used illicit drug around the world. It is also associated with vehicle crashes. According to US data, cannabis users have a 10-fold increase in car crash injury after adjusting for blood alcohol concentration. However, until recently, it was unknown how long cannabis remains in the blood stream or causes impairment – making it difficult to set any kind of reasonable limit in driving laws.

One study examined 30 male chronic daily cannabis smokers over a month of supervised abstinence to determine how long the active chemical from the drug remained in their blood (THC).

Of the 30 participants, 27 were positive when the study began. The chemical decreased gradually over the course of the study – 95 percent and then 85 percent were still positive on days eight and 22 respectively. After 33 days, one person still had detectable THC in his blood.

We know that acutely intoxicated cannabis smokers exhibit significant impairment in cognitive, perceptual and psychomotor tasks including the areas of attention, complex decision-making and reaction time. Some studies have also shown cognitive impairment that can last anywhere from seven to 28 days after use of the drug.

This study was the first to actually quantify the persistence of the chemical in the bloodstream and its findings are consistent with studies on the potential for lasting impairment. It was a relatively small study of chronic users and all participants were male – so more research will likely need to be done to see how the results compare in different populations.

Determining an acceptable blood limit for THC and driving is a more complex task than with alcohol. However, given the strong association between cannabis use and vehicle accidents, it is important to get a clear picture of the course and persistence of impairment so the laws can be set accordingly.



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Munchausen syndrome

One of the more difficult mental illnesses to discover or treat is known as Munchausen syndrome.

Munchausen syndrome occurs when an individual with a very deep need for attention pretends to be sick in order to get comfort, sympathy and treatment from medical professionals.

Often, people affected by Munchausen syndrome go to great lengths to be credible in faking their illness. They learn many details about the condition, its symptoms and treatments and can go so far as to tamper with diagnostic tests, purposefully injure themselves or subject themselves to unnecessary surgeries or other uncomfortable interventions. All of this in the quest to further their story and gain the medical attention they desire.

Munchausen syndrome is different from hypochondriasis because the Munchausen patient is truly faking and doesn’t actually believe they have an illness. It is also different from simple medical fraud because a person with Munchausen is not going to these lengths in pursuit of financial or other gain. They have a psychological need for the attention, sympathy and comfort they receive from caring medical professionals.

A related but separate condition is called Munchausen syndrome by proxy. This usually occurs when a parent or guardian causes their child to be treated for a non-existent illness. In these cases, the parent either fakes or causes injury or illness to the child or other dependent thus compelling him or her to be treated as a patient.

Recently, the idea of Munchausen by Internet has been gaining some popularity as well as media attention. This is due to the growing number of people faking illnesses online to gain support and sympathy through social media and online support groups. There have been some reported cases where a person has fabricated an entire character complete with family members and friends just to produce a believable story for online acquaintances. Not surprisingly, when these instances are discovered, the people who have been duped into believing the story are usually very upset and feel deeply betrayed.

Risk factors for developing Munchausen syndrome include childhood trauma or growing up with caregivers who were emotionally unavailable. It is also very common for individuals with Munchausen syndrome to experience another co-existing mental illness such as depression or an anxiety disorder.

Unfortunately, Munchausen syndrome is very difficult to treat. This is due in large part to the great lengths people with this condition will go to in order to avoid detection. Deception is at the heart of this illness.

If you suspect a loved one may have Munchausen syndrome, a few symptoms to look for include: dramatic stories about multiple medical problems; frequent hospitalizations; vague or inconsistent symptoms; eagerness for frequent tests or risky procedures; extensive knowledge of medical terminology; seeking treatment from many different doctors or health centers; reluctance to allow health professionals to talk with family or friends.

Blunt confrontation will likely cause stress and defensiveness in a person with Munchausen syndrome. Instead, try to have a gentle conversation about your concerns and avoid appearing angry or judgmental. Support, care and gentle direction toward psychological help are likely the best way forward. In cases where there is another mental illness such as depression, it can be very helpful if this condition is managed as well.



Life satisfaction & outlook

It may not come as a surprise to you, but research shows our life satisfaction and risk for depression are linked.

Yes – those with a high degree of satisfaction or contentment with their lives are also at a lower risk for depression while those with a more pessimistic outlook are also the ones more likely to become depressed.

Of course this can raise the question of whether it is a lack of satisfaction with life that causes depression or simply that a depressed person is less likely to feel satisfied. It turns out, both are largely determined by our genetic make up.

A study published out of the University of Oslo and the Norwegian Institute of Public Health compared information from 1500 sets of identical and fraternal twins to examine how depression risk is linked with overall lifetime satisfaction.

In the past, studies have found a person’s general life satisfaction tends to be similar over time. If you are satisfied with your life at one point in time, it is likely you will be satisfied at other times as well. This points to an underlying ‘disposition’ or tendency toward a positive or negative outlook.

By using identical twins who share 100 percent of their genetic material as well as fraternal twins who share only 50 percent of their genes, this study was able to determine the extent to which variation and covariation was due to genes or environmental influences.

Results found both men and women studied who met the criteria for depression also reported lower life satisfaction.

Genes could explain three quarters of the relationship between depression and life satisfaction while the remaining one quarter could be explained by environmental factors.

Specific genes were not identified in this study and the authors caution that their data points to the importance of genetics for explaining the differences between people but that estimates may vary across time and place.

But what does all of this mean to us? Is it possible to increase your life satisfaction and thus protect yourself from depression? Or is it all hard wired?

Even though our underlying disposition may be relatively stable over time, and our genes account more for this than our environment, actions in our daily lives can still provide pleasure that is important. Participating in activities we enjoy can certainly contribute to happiness and over time can work to improve our overall life satisfaction.

Depressed individuals who seek appropriate treatment may also find a corresponding improvement in their overall life satisfaction. If you or a loved one are experiencing depression, consider seeking professional help. There are effective treatments available.



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Positive impressions of aging

What do you think about getting older? Are you looking forward to your senior years; to wisdom, self-realization and the chance to look with satisfaction at the life you have created?

Or are you dreading the years that make up the latter part of your life? Are you fearful of a changing physical appearance, of medical concerns or a lack of purpose when you’ve finished your career?

According to research, the way we view old age will have quite an impact on the way we experience it.

This may not be entirely surprising to you. In general, our beliefs shape us. The things we hold true – whether about ourselves or the world around us – tend to be evident in our lives because they affect the way we interact with our environment.

Research out of Yale University has found that age stereotypes have an impact on the health of seniors. When stereotypes are negative, individuals are less likely to take preventive medical steps and can even die sooner. They are also more likely to have poor physical functioning and memory loss.

Individuals with a more positive outlook on aging experience better health with higher functioning and are even 44 percent more likely to fully recovery from a disability.

One study followed 660 adults for 23 years between 1975 and 1998. At the start of the study, participants answered questions to gain a sense of their age stereotypes. Among this group, those with positive beliefs about aging lived an average of 7.5 years longer than those with negative beliefs.

Researchers believe individuals with positive age stereotypes have a stronger will to live, which may help them adapt to the changes of older age. Similarly, those with negative stereotypes may have an increased cardiovascular response to stress.

Another study by the same group found those with positive beliefs about aging were more likely to eat well, exercise, limit alcohol consumption, stop smoking and visit their doctors regularly.

In another study again from the Yale researchers, almost 600 adults aged 70 and older were followed from 1998 to 2008 to examine the impact of age stereotypes on recovery from disability. Again, those with positive beliefs were much more likely to have good results and recover fully.

Beliefs and stereotypes about aging begin early in life and are reinforced by experiences and the way our society and families treat the elderly. North American culture is typically not very good at celebrating or valuing age – and this growing body of research suggests we would do well to change in this area.



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About the author...

Paul Latimer has over 25 years experience in clinical practice, research and administration. After obtaining his medical degree from Queen's University in Kingston, Ontario, he did psychiatric training at Queen's, Oxford and Temple Universities. After his residency he did a doctorate in medical science at McMaster University where he was also a Medical Research Council of Canada Scholar. Since 1983 he has been practicing psychiatry in Kelowna, BC where he has held many administrative positions and has done numerous clinical trials. He has published many scientific papers and one book on the psychophysiology of the functional bowel disorders. He is an avid photographer, skier and outdoorsman.

 

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The views expressed are strictly those of the author and not necessarily those of Castanet. Castanet presents its columns "as is" and does not warrant the contents.


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