Doctors (and residents) often require mental health services

I've been reading several stories related to the fatal shooting of Yale Doctor Vajinder Toor. The suspect in custody is another doctor: Lishan Wang. The current theory is that Dr. Wang had a confrontation with Dr. Toor while working at the Kingsbrook Jewish Medical Center in Brooklyn. It sounds like they were in the same residency program, but it also seems like some of the emotional issues that Dr. Wang was struggling with were never resolved. Did Dr. Wang suffer from serious anger issues? Was he mentally ill? Did he require mental health services?

It's such a shame to read stories where physicians went off the deep end. Last November, a military psychiatrist was involved in a shooting at Fort Hood (Military stress and tragedy at Fort Hood). Yesterday, we heard of a tragic shooting incident of a Yale physician.

When a doctor requires mental health services, are those services readily available? Doctors are frequently so busy that they may not make time to obtain the help they need, even if the services are readily available. As a result, some physicians build up all types of emotional issues, only to display them in bizarre behavior. In the case of Dr. Lishan Wang, it seems like he had some unresolved issues stemming from residency several years ago.

FDA Approves Saphris (asenapine)

Here it is from the FDA: FDA Approves Saphris to Treat Schizophrenia and Bipolar Disorder

The U.S. Food and Drug Administration has approved Saphris tablets (asenapine) to treat adults with schizophrenia, a chronic, severe and disabling brain disorder, and to treat bipolar I disorder in adults, a serious psychiatric disorder that causes shifts in a person's mood, energy, and ability to function.

“Mental illnesses like schizophrenia and bipolar disorder can be devastating to patients and families, requiring lifelong treatment and therapy,” said Thomas Laughren, M.D., director of the Division of Psychiatry Products in the FDA’s Center for Drug Evaluation and Research. “Effective medicines can help people with mental illness live more independent lives.”

The most common symptoms of schizophrenia include hearing voices, or seeing things that are not there, having false beliefs (for example, believing that others are controlling thoughts, reading minds, or plotting harm), and being inappropriately suspicious or paranoid. These thoughts may be terrifying and can cause fearfulness, withdrawal, agitation or violence.

Bipolar I disorder is a chronic, severe, and recurrent psychiatric disorder that causes alternating periods of depression and high, increased activity and restlessness, racing thoughts, talking fast, impulsive behavior, and a decreased need for sleep.
Saphris is in a class of drugs called atypical antipsychotics. All atypical antipsychotics contain a boxed warning, the FDA’s strongest warning. The warning alerts prescribers to an increased risk of death associated with off-label use of these drugs to treat behavioral problems in older people with dementia-related psychosis (a brain disorder that lessens the ability to remember, think, and reason). Saphris is not approved for these patients.

The efficacy of Saphris in treating schizophrenia was studied in three short-term placebo-controlled and active-drug controlled clinical trials. In two of the trials Saphris demonstrated superior efficacy compared to an inactive pill (placebo) in reducing the symptoms of schizophrenia.

The efficacy of Saphris in the treatment of bipolar disorder was studied in two short-term placebo-controlled and active-drug controlled clinical trials in which Saphris was shown to be superior to placebo in treating symptoms of bipolar disorder.

The most common adverse reactions reported by patients in clinical trials being treated for schizophrenia with Saphris were the inability to sit still or remain motionless (akathisia), decreased oral sensitivity (oral hypoesthesia) and drowsiness (somnolence).

The most common adverse reactions reported by patients in clinical trials using Saphris to treat bipolar disorder were drowsiness, dizziness, movement disorders other than akathisia and weight increase.

Saphris is manufactured by Schering-Plough, Kenilworth, N.J.

Click here to read this news release on the FDA website.

A Sad Story on CNN

CNN has a tragic story of a U.S. soldier who killed his fellow comrades in Iraq. With all that violence and mental trauma, this person was suffering and was receiving therapy at a stress-relief clinic treatment center. I'm not sure anyone can ever receive enough counseling and therapy for going through actual combat. My heart goes out to the grieving families.

Women and Mental Illness

What role does gender play in the diagnosis, course and treatment of mental illness? Are women more prone to mental illness? The U.S. Department of Health and Human Services' Office on Women's Health (OWH) has a report called "Action Steps for Improving Women's Mental Health." According to that report, women are twice as likely to suffer from major depression; three times as likely to attempt suicide; and they experience anxiety disorders two to three times more often than men. Why? What makes women so different from men?

CNN has a story about this interesting topic and highlights the personal stories of a few individuals. As technology improves brain imaging abilities and we gain a better understanding of how hormones affect our mood and cognition, are we as healthcare professionals moving in the right direction when it comes to the management of mental conditions?

Schizophrenia on CNN: Young Teenager

If you look on CNN.com, there's an interesting story about a teenager who suffers from schizophrenia. It's quite a compelling story about how he hears voices in his head. His mom quits her job to take care of him. I personally know several young men who developed schizophrenia and it's been a struggle for their families. Even with advances in medical technology, schizophrenia remains a very difficult disorder to treat. Make sure you go out and watch the movie titled, "the Soloist."