Recommend: Dr. Oren Mason’s blog, Attentionality

Five years ago, Dr. Oren Mason started an ADHD blog called Attentionality, made an inaugural post, and forgot about it. In that post, he asked, “Do you believe in ADHD?” Now, this year, Dr. Mason has resurrected his blog with six new posts in a single week and it’s looking pretty interesting. So far, he is taking on those who would answer “no” to his question and challenging them to look at the science, dispelling myths about ADHD, illuminating the diagnosis of ADHD by comparing it to detecting global warming, and providing some critical advice to parents with ADHD who want to help their children with ADHD.

Take a look for yourself: Attentionality.

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Dr. Sarkis Assists the AACAP

Dr. Elias SarkisDr. Sarkis recently assisted the American Academy of Child and Adolescent Psychiatry with their revision of the ADHD Parents Medication Guide, which you can find here. The old version is still posted so look for the revised version, dated July 2013, soon.

 

These are some excerpts from AACAP’s letter to Dr. Sarkis:

 

On behalf of the American Academy of Child and Adolescent Psychiatry (AACAP) as well as AACAP’s Pediatric Psychopharmacology Initiative (PPI) we would like to thank you for your contributions to the revision of the ADHD Parents Medication Guide. Your guidance and expertise throughout the revision process have been invaluable.

We truly appreciate your support in our efforts to ensure we are providing the best information possible to patients and families about treatment for children and adolescents with ADHD.

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Kathy gets mail

Recently, one of our patients moved to another state and sent “a little note” that meant a lot to us.

Dear Miss Kathy,

Just a little note to let you know how much you are missed. We are having a difficult time finding a doctor for our son. Your compassion, caring, kindness, and genuine concern for your patients sets you apart – but we knew that already. Thank you for your love and support. I pray we can find someone to help our son here, but you will always have a special place in our hearts. God bless.

(names removed)

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Dr. Catrina Luca

Last month, we briefly introduced you to Dr. Catrina Wilkins (now Dr. Luca), our new child and adolescent psychiatrist. Most recently she was working as a Clinical Assistant Professor at the University of Florida Division of Child and Adolescent Psychiatry. Before that she had been focusing her energy and efforts on her family. During that time, she was also thinking about the kind of psychiatrist she wants to be. Now that she is back in the chair, her vision for herself and the kind of psychiatry she wants to practice sounds sharp and well-defined. It begins with being well-rounded.

“It’s important to know all of the mechanics of medicine and to know the mechanics of how to do an interview.” Luca said. “Anybody can learn that. Anybody can get a checklist and say, ‘This is what I need to know.’ My primary concern is, number one, who you are as a person, because the better I understand that, the better I’m going to be able to come up with a treatment plan that you’re actually going to want to do; and number two, that you view me, not as part of the family, but as someone who is involved not just in your psychiatric care but in your care as a person—definitely a more holistic approach. It’s not unheard of for me to talk about diet, definitely sleep, family dynamics—I want to cover your entire life because all of that is playing a role in what I’m seeing in front of me.”

An important part of this vision for Dr. Luca is an emphasis on therapy. During her residency training, she pushed hard to have more therapy supervisors. While most of her fellow resident physicians had one or two therapy advisors, she had three.

“I was the squeaky wheel, honesty. I just kept asking. I kept making it known that this is what I really want to do.”

This was at time when there was an emerging emphasis on medical interventions in psychiatry, according to Dr. Luca, and she doesn’t feel that this has changed since then.

“It has become even more biologically focused. Medication is being prescribed a lot more.”

Part of that, she believes, is the time crunch many psychiatrists are working under.

“When you put a child psychiatrist in a very time-limited arena, you start shaving off a lot of [therapy]. It becomes, ‘How’s the medication. Is he tolerating it? Are you getting results? Okay, good.’ I don’t think it’s because the physician wants to be like that, but the demands are there. You have a schedule with plenty of patients that need to be seen, but unless you’re spending 30 minutes with each patient, you’re not there.”

As a child psychiatrist, part of being there for children is counseling the parents. Dr. Luca says she sometimes sees parents overcompensating for their child’s illness.

“You’re still the parent.” Luca said. “You still set the boundaries. You still have rules. Do you flex them and bend them some to better accommodate and give the child room? Yeah. But you don’t throw the rules out the window because of some diagnosis.”

Still, her dissent from what she sees as a decline of therapy and an over-emphasis on medication does not mean that she has an aversion to using medications. She does, however, often see that parents are worried about medications changing their children, or worrying that they won’t be themselves. This, she explains, isn’t how it works.

“If they’re depressed, I make them less depressed so they’re able to make better decisions and they’re more available to you to parent. A depressed child is not going to be parented very well. An anxious child is not going to be parented very well.”

At the heart of Dr. Luca’s perspective is a strong desire that she expresses this way:

“I want to see (specifically children) get the care that they need and not be stigmatized.”

It’s what drives her to serve underprivileged populations while maintaining an emphasis on personal responsibility. It’s what drove her work on programs in ADHD and law enforcement, in which she worked with law enforcement officers to help them understand and know how to handle people with ADHD in the justice system. And it’s what drives her work here at Sarkis Family Psychiatry. We are glad to have her here.

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Stigma: your story might be the best antidote

Imagine that you have gone to the grocery store and used one of those free blood-pressure machines by the pharmacy. The reading you get is high: 190/102. You would normally assume that the machine is wrong, but you’ve had similar readings at several different machines over past few months. You know that you’ve been under a lot of stress over the last couple of years. You’ve made some mistakes at work, and you think they might be looking to replace you. Since then, your diet has suffered a lot. You think about going to the doctor, but you don’t think you can bear the consequences. If they take your blood pressure and get a similar reading, then you know you’ll be diagnosed. You’ll be a person with hypertension. People will start to look at you differently. Your boss might see it as another reason to get rid of you. Then you might have trouble getting a new job if you don’t keep quiet about your condition. Everybody will be nervous around you, thinking that they have to be careful not to upset you lest you have a heart-attack. God help you if anyone ever sees you walking out of a cardiologist’s office. It might be better to wait. Maybe you can control this yourself.

If this seems like an overreaction, it’s because we don’t look at hypertension this way. We don’t tend to think of people with hypertension as a distinct class of people with shared characteristics: the hypertensive. We tend to see high blood pressure as just one of many common illnesses that we’re likely to get someday. Going to the doctor is more of a mark of common sense than one of shame. It certainly shouldn’t ruin our careers and friendships. Unfortunately, these attitudes are less common when the illness in question is a mental illness. In fact, a 2003 study of depressed patients found that 67% expected stigma to negatively affect their careers, and almost a quarter expected it to affect their friendships, and a 2007 study found that, while more than 50% of people surveyed believed that people with mental illnesses are treated with care and sympathy, less than 25% of those with mental illness agreed. These anxieties are in addition to the suffering caused by mental illness itself.

We might assume that the source of this stigma lay with the misconceptions of an ill-informed general public, but a 2011 position paper from The Canadian Psychiatric Association suggested that stigma is just as prevalent among physicians (including psychiatrists) as it is in the general population. Furthermore, other research finds that some attempts to shield patients from stigma can be counter-productive. A Johns Hopkins study found that when medical centers keep psychiatric records separate from a patient’s other records and put greater limits on those records’ accessibility, they increased the likelihood that patients would be hospitalized.

Stigma appears to be a tricky problem. But researchers have been studying the ways we try to deal with it. A 2007 study from the UK tested programs aimed at reducing stigma and found that, among the strategies studied, testimonials from patients about their struggles with mental illness and their experiences with treatment were the most effective strategy for reducing stigma.

Given the consequences of stigma, we want to do everything we can to reduce it. Earlier this year, we held our first Stop the Stigma event. It was good to see everyone who came and enjoyed themselves, and no one seemed embarrassed about the purpose of the event. Since testimonials have been shown to be effective, we encourage you to leave any testimonials you might want to share in our comment section. It just might encourage another person to finally seek the help they need.

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Welcome, Catrina N. Wilkins, MD

Sarkis Family Psychiatry is very happy to have child and adolescent psychiatrist Dr. Catrina Wilkins joining the staff. Dr. Wilkins trained at UF and will be joining us July 1st. Here is her bio:

Originally from Miami, FL , Dr. Catrina N. Wilkins earned her Bachelor’s of Science at the University of Miami and her Medical Doctorate from the University of Miami Leonard M. Miller School of Medicine. She completed her Adult Psychiatry residency at the University of Florida. During her third year of training she was chosen to serve as a Chief Resident, a position typically reserved for 4th year residents. She went on to complete her training as a Child and Adolescent Psychiatrist. During her final year of training she was selected to serve as a Chief Child and Adolescent Fellow.

In 2011, as part of her desire to perpetuate a better understanding of child and adolescent psychiatry and its nuances, Dr. Wilkins joined the University of Florida Division of Child and Adolescent Psychiatry as a Clinical Assistant Professor. During her time in that position, she created lectures and teaching sessions to educate physician assistants, medical students, pediatric residents, adult psychiatry residents and child and adolescent fellows on various topics of interest and specialization including ADHD, community and minority mental health, as well as mental health services for youth in juvenile justice settings.

Historically, Dr. Wilkins has had a penchant for serving underserved populations.  From her undergraduate experiences to the present, she has focused on various community endeavors to fulfill the desire to help those with limited access and education about health and ultimately mental health. She continues to be involved in the community via presentations, lectures and training sessions for various groups which include community pediatricians, Crisis Intervention Team officers, Gainesville Police Department, Alachua Sheriff’s Office, and Reichert House in an effort to spread awareness of child and adolescent mental health concerns, as well as the interplay of ADHD with the justice system. The specific area of interest (ADHD and law enforcement) has also been shared at the annual international CHADD conference the last 3 years.

Over the last 6 years, Dr. Wilkins has had the opportunity to train and work in several different arenas including Gainesville Job Corps, Marion County Juvenile Jail, Meridian Behavioral Healthcare, as well as private clinics thus affording exposure to a wide range of clinical settings and creating a foundation of broad clinical experience.

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Kathy Noffsinger’s New Blog

Self-control, self awareness, better mood, better focus—these are some of the benefits of meditation, and they are also things that many parents would love to see their children achieve. Teaching young children to self-soothe can lay the foundation for raising emotionally healthy teenagers. But how do you get a temperamental toddler to meditate? Sitting quietly without moving sounds suspiciously like time-out—like punishment. In some ways, though, the goals of time-out and meditation are not so different. Pediatric Nurse Practitioner Kathy Noffsinger begins her parenting blog by talking about teaching meditation to children.

Meditation for Children
by Kathy Noffisinger

Even before they’re born, infants have ways of calming themselves. When we see images of infants in the womb, they are often sucking their thumbs. Thumb-sucking is soothing to infants, which is why pacifiers work so well, and in the womb, it helps the pallet spread as it develops. But if that pacifier is taken away, and the child doesn’t learn self-calming techniques before language other forms of self-expression before develop, we start to see tantrums. If parents give in to the tantrums, then the child learns tantruming as a technique instead of self-soothing.

When you’re four years old, you don’t have much control of your environment. When a child is throwing a tantrum, and parents give in, that child learns to get some control by throwing a tantrum. A lot of times we act as the command center. We keep the control, and then we’re surprised when kids can’t control themselves later. Well, did we teach them or did we just overpower them? Starting to give some warnings and choices helps them begin to think about how they’re going to respond when they’re losing it. You can give the child some control through those choices. This can lay the groundwork for meditation by creating a thinking child.

You can’t ask a four-year-old to do breathing meditations, but you can teach them self-calming techniques. A lot of people worry about giving in, so they’ll leave the toddler. That is one technique. But another is taking the toddler into your lap and giving them a big bear-hug and telling them they’re alright: “You’re alright. You just got a little upset. Relax your muscles.” So you can start with two-year-olds. You just have to start on their developmental level.

Anything that creates a sense of closeness or pressure is a good place to start. Beanbag chairs are good. They’re like chairs that hug you. Having kids roll on the floor also works. Kids love closets and tents, so you can make a space like that for them. It’s a space they can go to and learn to go to when they get upset. Say a child hits you. You can say, “Okay, you’re going to time-out. Do you want to go to your tent?” So you’re teaching that when they’re upset, they have a choice to self-soothe.

Now you can add guided imagery. For a toddler, it may not be a beach in the Caribbean; it may be a scene from their favorite movie. You can ask them, “What’s Barney doing now?”

When you’re ready to teach them to meditate, one of the things that I think is fun is that you lay them like crosswork. Have one child lie down on her back. Then have the other child lay his head on the other one’s belly. You can make a chain of them like this:

Have each person relax and stay quiet and focus on the other person’s breathing. They’ll feel their head rising and falling as the other child breathes, and they’ll feel themselves raising the other child’s head with their own breathing. You can get a whole family to do this for five minutes. It doesn’t take long. It also helps you practice breathing from your belly, which is a good way to reduce stress. So it’s good for Mom and Dad’s health, too.

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