Month: July 2022

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Perinatal Mental Illness

Perinatal Mental Illness
baby blues mental illness

Dr. Kartiki Churi, M.D.

Pregnancy is commonly referred to as an exciting and joyous time in a woman’s life, albeit with significant physical, hormonal, and psychological changes. Tremendous shifts occur in the mothers social, familial, professional, and interpersonal world. It is not uncommon for pregnant or postpartum women to experience mood changes, tearfulness and feel easily overwhelmed, commonly known as baby blues. While baby blues resolve on their own and quickly, perinatal mental illness tends to persist and severely impact the mother’s ability to return to normal function. “Perinatal” refers to the period while one is pregnant and after the baby is born.

Perinatal mental illness, also referred to as maternal mental health conditions, commonly include:

  • Depression
  • Anxiety and anxiety spectrum illnesses like obsessive compulsive disorder, post traumatic disorder, panic disorder
  • Psychotic symptoms which commonly present with bipolar disorder
  • Substance use disorders
  • Complicated grief after perinatal loss

Perinatal mental illness is one of the most common complications of pregnancy and post-partum impacts 1 out of 5 women in the United States. It has a substantial negative impact on maternal and infant health. Women with untreated or undertreated perinatal illness are unlikely to take care of themselves, may struggle with substance use, have poor nutrition, have none to very few positive interactions with the baby, experience nursing challenges, and question their competence as a parent. Suicide and overdose are the leading causes of death in the first year postpartum, with close to 100% of these deaths deemed as preventable. Children born to mothers with untreated perinatal mental illness are likely to have low birth weight, preterm birth, excessive fussiness, difficulty latching, and behavioral, emotional, and cognitive delays. 

There are several reasons women hesitate to seek treatment during or after pregnancy, and most revolve around stigma and lack of awareness of the various treatment options available. Oftentimes, depressed and anxious postpartum women feel like a failure in their role as a parent and confront a great deal of shame, which can be a barrier in expressing their struggles. Some women keep expecting the symptoms to resolve and others fear that they will be labeled as an incompetent parent. Another common concern that several pregnant or nursing women have is the impact of medication on the embryo or infant. These and other barriers prevent the early detection and treatment of inherently treatable illness, and many women continue to suffer the short- and long-term consequences of perinatal mental illness. It does not have to be this way! With proper and timely treatment, most women experience symptom improvement and meaningful quality of life.

There are several medication and non-medication options available that are commonly and successfully used to treat maternal mental health conditions.  Psychotherapy, including Cognitive Behavioral Therapy (CBT), Interpersonal Therapy (IPT) and several other therapy methods can be very effective for certain perinatal symptoms and illnesses. There are times when the nature of illness and intensity of the symptoms require medication consideration. There are several different ways in which perinatal mental illness could present. For instance, it might be the first onset of symptoms, with no prior mental health history. In other cases, a woman with prior mental health treatment history, might need to restart medication due to relapse of symptoms. Others might need adjustment in medication doses due to change in symptoms or switch to an alternate treatment option that is safely prescribed through pregnancy and after. In any of these scenarios, it is important to talk with your doctor and know what treatment options and venues are available to address your specific symptoms. 

At FCC, we screen, evaluate, and treat perinatal mental health disorders with strong focus on the bio-psycho-social model of care. We collaborate with your primary care physician, obstetrician, and your social support system to empower you to make an informed treatment decision. Woman's mental health during pregnancy and the phase after comes with its unique challenges and can impact various aspects of her life. You are not alone on this journey.

Call today and schedule a visit with the Family Care Center and let us help your transition to parenthood be an enriching experience!

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Home and Relationship Improvements

Home Improvements and Mental Health Blog
home and relationship improvements

 

It’s Spring and time for home improvements! Maybe you are already spending your weekends in and out of big Home and Garden stores, gathering tools or plants or light fixtures to make your home a nicer place to live. But what are you doing to improve the inside of your home when it comes to relationships? Do you have plans for improving the happiness and contentment in your home?

Spring can be a good time to take stock of what you need relationally, not just a rake or a new faucet.  Do you need more family time? Better budgeting? How can you get the kids to DO their chores? Or their homework?

It’s also a good time to take stock of what you need personally. Maybe you made some New Years’ resolutions, how are those going for you?  Maybe you vowed to lose weight or increase your exercise, maybe you wanted to save more money or follow through on a hobby? Perhaps your goals were more serious, like drinking less, or quitting smoking. If you are doing great in these resolutions, then congratulations! But many of us fall short in some of these personal goals, even if we are making some improvements.

Increase Awareness of Areas to Personally Improve

Improvements of any kind begin with paying attention.  Maybe you did this with your car or home. When we had the hailstorms last year, we went over the outside of houses with a fine tooth comb.  You walked around and decided what needed fixing and prioritized… maybe windows first and dents second, and then you decided if you were prepared to address the problem.

Identifying and prioritizing can also be helpful when improving your relationships. You can do the same type of interpersonal inventory in your home. Does the family eat together, or on the fly? Sitting in the living room or actually at a dining room table? Does everyone get home and immediately retreat into their own designated spaces in the house, or do they spend time together talking about their day?

Plan Productive Changes

Once you identify areas of potential improvement, you then have to come up with a plan to implement productive changes in your personal life. Just like fixing the things around your house, home improvement goals can include improvements in relationships. Can you increase the amount of quality time you spend with your kids? Or your friends? Or maybe you just need to laugh more. You can plan activities and behaviors in your life that will lead to these things. Where would you obtain this extra time from your busy schedule? If we really look at what we’re doing throughout the week, we can find time that we’re doing other things, like videogaming or checking your smartphone, rather than things that can improve our personal lives.

Track and Evaluate

Goals like these can be hard to measure, but not impossible. To really know if you’re making progress, you must track how often or how frequently you’re engaging in behaviors that will lead you to your goals.  For example, how much time are you spending on the floor, playing with your children? Could you increase it by a half an hour? Or try to do it 3 times a week? Could you perhaps take some of your allotted exercise time and turn that into a relationship-building exercise, like riding a bike with your children or companion?

Measure Improving Relationships

Better relationships are a function of better communication. Like measuring and tracking your goals, you can measure improved communication skills. Here are a few ways to do that:

  • Possible Problem: Have you been accused of not talking enough to the people in your life?

Solution#1:  Increase the amount of time you talk. Put the timer on and pay attention.

  • Possible Problem: Maybe you feel like you are not talking about important topics.

Solution#2:  Improve the content of your conversation, deliberately. What is important to you? What is important to the other person?

  • Possible Problem: Perhaps you avoid difficult topics?

Solution #3:  Be brave and ask, “Hey, can we talk about this?”

  • Possible Problem: Do you say things you shouldn’t? (You aren’t alone!)

Solution#4:  Think before you speak, “Will this hurt or offend?”

  • Possible Problem: Oops, you have already offended someone.

Solution #5:  Own it. Apologize and say it better; a re-do can go a long way and practice makes perfect.

The Family Care Center Can Help

So those are just some ideas that might be helpful for personal home improvements. Any one of our specialists at family Care Center can help with this. We encourage all our clients to be their best selves in hopes that they will enjoy their lives more and that their home can be a pleasanter place to live. Maybe you could plant a garden with your loved ones; who knows, other seeds may get planted that will be beautiful for years to come.

Everyone has unique challenges to these seemingly simple suggestions; and everyone has their own personal priorities. What do you want to improve? The choice is yours.

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Responding to the Rise in Teen Suicide

responding to the rise in teen suicide

 

Since 2015, in El Paso county Colorado, over 40 youths aged 10-17 have killed themselves.  This number is higher than other counties in Colorado, and higher than most counties in the United States. For every one of those children, there are countless individuals, parents, brothers and sisters, who will never fully emotionally heal. For each suicide, there are thousands of others, friends, neighbors, teachers, teammates, who will never forget. Recent studies released by the National Institutes of Mental Health report that suicides have risen 28% in the past 17 years.  In 2018, The American Foundation for Suicide Prevention found that hospital admissions for both suicidal thoughts and actions has doubled for patients aged 5-17 years of age.

What is going on?

While there are many associative factors in proximity of teen suicide. Children of all ages react strongly to issues such as the suicide of a friend, family discord, substance use, a recent argument with a parent, parental addiction, the current polarized political environment, bullying, a romantic break-up, family abuse and school pressures to succeed.  Every youth that dies by suicide will have a unique combination of these factors. Every youth that dies by suicide compels us to ask, what could we have done to prevent it?

Being a teen in this decade is challenging. The age-old factors are still in play, self- esteem, depression, popularity, academic success, drugs and alcohol, but now these pressures are amplified by social media. Who appears the happiest? Who seems popular or connected or successful? Teens inadvertently are measuring themselves against social media impressions almost hourly, and every day.

What can we do?

Talk. We can talk, we can ask, we can reassure, we can hug and then we can talk again. Tell your child that no matter how bleak things may seem, there is ALWAYS a way forward.  Tell them how much you love them and believe in them. And that no matter how much you may disagree with them at times, their life is unique and precious. Make them promise to never forget that you love them, and to promise that they will not harm themselves.

We can insist that prevention “Hot Lines” are on their phones and the Text Crisis Number is in their phone contacts. Be sure that your child’s friends have your contact information, and that you have theirs.  

Crisis text 741741 or 1 (800) 273-TALK

 Many times, a young person who feels suicidal will not come forward and tell even a friend, let alone a parent or counselor. But many times, IF ASKED, the youth will admit they have had suicidal thoughts. The fastest rising group of suicidal youths are in grade school and middle school. While this still represents a low number of actual cases, the trend is alarming.  Waiting until your child is in high school to talk about suicide prevention is waiting too late.

How Do We Increase Resilience?

As adults we know that there are times when we feel down and overwhelmed by our circumstances, confused about our future, stressed about our relationships. Teenagers have the same struggles but are less mature and often feel unequipped to handle their problems, are perhaps unwilling to open up to their parents, or peers, and have limited experience with the concept of “this too, shall pass.” Transient problems such as a bad grade, a break up or family strife can seem insurmountable, can make them feel trapped and want to escape at any cost.

As mental health professionals, we know that many teens have suicidal thoughts. And that we can help them gain perspective and increase their resiliency through therapy and sometimes medication.  Therapy can give a young person a place to open up about private feelings and troubled relationships, and together the therapist and the teen can create solutions that make sense for their unique circumstances.

Suicidal thoughts become more dangerous when a teen reports an increase in their frequency or severity; a progression from the worrisome “I wish I had never been born” to the more escalated version of “I want to die” and having a specific plan and the intention to act on it.

The Good News

The good news is that we can help by not ignoring warning signs of pressures and associated family stressors. Sometimes it is helpful to begin this important conversation by asking your child about their friends.

Ask your teen if any of their friends have confided in them as having suicidal thoughts.  If they answer yes, try not to overreact, and ask them what they think is going on with their friend. Express sympathy then, ask who they can talk to at school or in that friend’s home.  Encourage your child to speak up on their friend’s behalf. Empower them. Make a plan with your child to contact an appropriate adult. Then ask your own child if they have ever felt that way. Even when a teen denies suicidal ideation, if they seem stressed or report feeling stressed, if the associated factors are present, bring them to a counselor that can assess them.  Encourage them that even if they do not need help now, there is help available anytime and demystify the treatment channels.  In the 2017 Healthy Kids Colorado Survey, 71% of teens in High School in El Paso County report that they have an adult to go to for help with a serious problem, and 66.1% are involved with an extracurricular activity at school, both considered to be strong protective factors against suicide.  Be that adult, for your child, for any child.

Do not be afraid to ask your child about suicide. Do not be hesitant to encourage them that help and hope is available to them and to their friends.

Talk. Encourage. Hug. Repeat.

In Colorado: 1(844) 943-TALK (8255) or Text “TALK” TO 38255.

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Relationship Risks During Deployment

Military Relationship Blog
relationships and military deployment

The Internet is filled with video snippets of joyful family reunions of military service members returning from deployment. It’s hard not to stop in the middle of your social media feed to watch fathers, mothers, sons and daughters embrace at sporting events, school lunches and even at their own front door. We stop for a moment, sharing in the love we see, and gratefully acknowledging to ourselves in that moment the sacrifice that all family members make when a loved one is deployed.

 What we don’t see is below the joyful surface: the hidden land mines that can get embedded in relationships during deployment.  The relentless pressure of deployment separation can deteriorate even the strongest marriage.  Combat deployment places a whole family at risk for losing a loved one. If the loved one comes home, however, the second risk is losing love itself.

 Combat is tough on marriages and always has been. But as America passes 17 years of constant combat deployment, new threats to military marriages have emerged.  The ability to be in constant communication with a deployed service member is a good example. While couples from previous wars would write lengthy, supportive love letters, now couples can talk normally about everyday issues. This constant, instantaneous communication also creates an illusion that the couple is in the same emotional space, even when everyday circumstances are vastly different for each individual. 

 Statistics bear out this recent stress.  In a 2007 study, the Army determined that the divorce rate was about 50 percent higher for those who deployed than those who hadn’t.  “After Operation Iraqi Freedom began, there was an increase of 3,024 divorces Army-wide,” the study, authored by the  Army War College’s Col. Mearen Charlene Bethea, found. “Total Army divorces doubled from the 2000 fiscal year – an increase of nearly 5,000 divorces over this period.  A year before September 11, total active duty Army divorces numbered 5,658 among 255,353 marriages. Divorces rose a year later to 7,047 in 248,180 marriages.”

 Between September 11, 2001 and 2015, 1.33 million individuals serving with the Army have been deployed abroad.  An estimated 225,000 soldiers have deployed at least three times. Chances are, here in Colorado Springs, you know someone in this category. Chances are, you know someone whose marriage has hit the dirt as a casualty of deployment stress.

 What exactly is happening? It is difficult to say for certain, but the military looked at the issue and found a common theme: Exposure to combat and the bloodshed that goes with it will increase the likelihood of divorce.

Why, though? What specifically breaks the bonds of a relationship?  What we do know is that when soldiers are exposed to combat conditions, a survival instinct is triggered that may result in hyper-vigilance and suspicion or create an instinct for emotional isolation to protect oneself. Some deployed military describe their experience in retrospect as feeling numb inside.  The backdrop of war can inhibit emotional communication at times and can create a growing mistrust. What happens to trust in this situation? Different individuals react differently, of course.

 There are three important connections in a relationship or marriage that can be disrupted by deployment separation: Fun, Fidelity and Philosophy.

Deployments Disrupts the Ability of Couples to Have Fun

 A couple is challenged by their inability to play together and just have fun, both during the deployment and afterwards.  Often combat creates a guilt reaction, and fun is no longer valid or meaningful. Couples want to laugh and enjoy themselves!  One of the first questions asked in mental health assessments is whether a person still finds pleasure and enjoyment in their life.  Healthy relationships and healthy couples will share a variety of activities that may seem relatively insignificant on their own, but collectively create a framework for shared happiness.  The strongest relationships are found in couples that enjoy each other and their shared activities.  Fun activities such as bicycling, bowling, hiking, video-gaming, travel, golfing, eating and laughing can be part of the wellspring of happiness and satisfaction in a relationship.  Recreation is a key in relieving stress and bringing satisfaction to our lives. Sharing it is healthy and often the basis for our social interactions. A couple separated by deployment must rely on recounting stories of fun, instead of experiencing the fun together.  Often new friends can create new opportunities for bonds that complicate their old bonds. Young military service members may find that they want to party more while deployed, perhaps in the face of dangerous conditions, reverting to a previous time that is more carefree. Married men and women socializing and partying with a background of loneliness and stress create an unanticipated risk.

Deployments Disrupt the Emotional Bond of Physical Intimacy

The separation of deployment impedes the ability for couples to be physically intimate, which creates emotional isolation. While deployed couples often joke about this, the deprivation is real. Physical touch is part of the comfort of love and bonds people together. Again, while the cell phone can keep a couple “talking,” the social media of separated couples presents a risk. Innocent friendships can be detected in social media from afar and misinterpreted by a spouse or a partner. It is easy to become jealous of a person who is simply laughing and enjoying life with your loved one, when you are separated by many miles. Strong bonds between two adults who are separated from their significant others during deployment can seem disloyal, and of course sometimes they are.

 Emotional infidelity can place the “accused” on the defensive, causing them to respond in anger or indignation that “nothing ever happened.”  Suspicion can fracture trust quickly during separation and deployment.  Sexual intimacy is an integral part of a committed relationship; consistent deprivation of this intimacy is asking for trouble.

 Affairs during military deployment are far too common. Hurt and rejection are tough emotions to grapple with under supportive, close –range circumstances.  Dealing with infidelity long distance limits communication and the opportunities to rebuilt trust are compromised. 

Deployments Relationships Can Be Strengthened by Shared Philosophy

Do people really get married for philosophical reasons? Absolutely. A background of shared beliefs is a powerful connector that gives a couple a bond of a higher purpose, one they are working on together. Some couples want to re-create the strength and security of their families of origin, others want to improve upon a history of family dysfunction, creating a better life for themselves and their families. Individuals in a relationship that are separated by deployment can often reach deep into this area of connection and gather strength from the shared purpose of their military service. Defining a shared philosophy creates the kind of bond that can be used for strength in times of prolonged separation.

 Couples that share a purpose can lean on these values for decisions on parenting, finance and family goal-setting. When they communicate about these goals, and act on them, they create a bond of trust and shared purpose, whether it is cheering their children at a soccer game, a scout meeting, going to church, or just being neighborly and supportive of other military families.

Overcome the Disruption through Communication and Effort

Communication is the biggest liability to trust. Communication during deployment takes effort, creativity, and love. Relationships can survive deployment, but it takes awareness, self-control and the decision to communicate all along the way. No marriage or relationship is complete without it.

 Repeated exposure to combat can break bonds and create barriers.  War can shroud our loved ones in protective emotional Kevlar. Military deployment strains these three types of connections in every relationship.  Awareness and communication and are key elements needed to keep the physical distance in a deployment from becoming an emotional distance. 

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Logotherapy and Meaningfulness

Logotherapy and Meaningfulness Blog
logotherapy and meaningfulness

 

In the book, Man’s Search for Meaning, Viktor Frankl recounts his experiences in 4 concentration camps, including Auschwitz, from 1942 to 1945.  Frankl experienced every form of suffering and loss one can endure and witnessed this suffering everyday amongst his peers.  He noted distinctions in those who survived with integrity and those whose lost hope and ‘ran to the fences.’  He hypothesized and later conceptualized, the main distinction between these two groups lies in the belief that there is greater purpose and meaningfulness to be found in life beyond that of personal fulfillment and happiness. 

Logotherapy is predicated on the belief that healthy humans maintain a will to find and cultivate meaningfulness in their lives.  Logotherapy differs from previous theories of human development from Freud and Adler, that individuals are motivated by a pursuit of pleasure and a pursuit of power, respectively. 

In sessions of Logotherapy, we process that meaningfulness can be found through the creation of a work or doing a deed and experiencing phenomena and interpersonal relationship.  Most importantly, we must address our attitude toward unavoidable suffering.

I have found success in motivating clients to pursue and cultivate meaningfulness over happiness and convenience or comfort.  I have found this especially resonates with individuals who have tried and failed to find purpose and direction in seeking congruence with our post-modernistic culture including professional failures and relationship dysfunction.  Rarely have I found the promotion of unconditional, positive, self-regard to lead to lasting, meaningful change in a client or even the diminished of any particular pathology whatsoever.  The inevitable end of a postmodern worldview is Nihilism, which resonates with the apathy of depression, but is a logical and existential fallacy.    

If you are interested in learning more about Logotherapy and understanding the hierarchical truths regarding the pursuit of meaningfulness in spite of the inevitability of suffering, I would recommend two very important pieces of literature.

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Mental Health Care for Seniors

Senior Citizen Mental Health Blog
Image

July 18th 2022
Dr. Jennifer Osborne

We all want to thrive in our later years.  Yet many older adults suffer from mental illness and it often goes unrecognized or untreated.  

Aging comes with many unique challenges.  There can be loses and changes.  Grieving the death of family and friends.  Adjusting to retirement after a long and fulfilling career.  A change in living environment and loss of independence.  New financial worries.  New or worsening medical illness.  Declines in function or abilities.  Just to name a few.  

Addressing mental health in the elderly requires looking at this whole picture.  How do these many factors impact one’s mental health?  And in turn how does our mental health impact our function and ability to thrive later in life? 

Some common mental health issues that can occur as we age include:

  • depression and other mood disorders
  • anxiety disorders
  • cognitive disorders including dementia
  • grief
  • substance abuse

Early recognition and intervention are key.

Unfortunately, mental health is often overlooked and undertreated among older adults and senior citizens.  This may be due to reluctance to seek treatment related to stigma.  It may also be because mental health care often takes a “back seat” to other pressing medical needs in this age group.  Access to mental health care can also be a challenge for many due to lack of transportation, functional limitations, or financial barriers.  By improving education, community outreach, and availability of care we can begin to help. 

Let me provide you with one example:  Jane is a 72-year-old retired teacher.  She lost her husband of 49 years ago this past year.  Even though it is going on a year since his passing, she is still grieving and finds herself tearful and isolating often.  She is also grieving the loss of the life they built together.  Most of their social activities and travel plans had been together. She had not considered going through these times alone.  It has just been easier to stop doing them all together.  In recent months she finds herself worrying much more.  She has started to worry more about her own health.  Her primary care doctor recently started her on medication for blood pressure and for her thyroid.  It is hard now to remember to take medications every day and at certain times she finds that she may miss a few days a week.  Her doctor has asked her to come in more frequently to monitor these conditions. She has become less comfortable driving distances too far from her home, so she has not followed up with the frequency that was recommended. 

She is starting to have difficulty falling asleep and will lay awake at night letting her many worries spin around in her head.  She started having 2-3 drinks in the evenings to help calm her nerves.  Jane isolates more in her home now which has worried family. Her only daughter lives out of town but has picked up on some concerns.  She has noticed her mom making errors paying her bills and wonders if she is eating well enough.  Jane admittedly reports having lost some weight and has lost interest in food.  Planning and preparing meals for just one person is just not worth it in her mind.  Her daughter has started to put some pressure on her to consider a move to an assisted living facility.  She thinks she would do better with more social activity; however, Jane cannot imagine leaving her home and the memories that come with it.

Jane’s story has many common themes.  How can we help Jane and others with similar struggles?

Appropriate screening and assessment for mental health concerns are what is needed.

An assessment which considers the whole patient.  Including incorporating their medical and cognitive diagnoses.  Including social, environmental, financial stressors, and functional impairment.  Treatment options should include a multidisciplinary approach, which includes collaboration with their other physicians or care providers and may include medications or talk therapy as well as interventions within their family systems or environment.  

Family Care Center has a mission to improve access to mental health care for all who need it.  We aim to provide a broad range of services to best assess and treat mental health concerns.  A collaborative team of psychiatrists, psychologists, and licensed therapists work together to best address your individual needs.  Everyone deserves a chance to thrive as they age or at any stage of life. 

Do not let mental illness get in the way.  We are here to help.