Adults who suffer migraine headaches are more apt to have post-traumatic stress disorder (PTSD) than the general population, a new study suggests. And having PTSD and migraine may lead to greater headache-related disability.

Excerpts follow:

<snip>

Among a group of 593 adults with migraine, PTSD was present in roughly 30 percent of those who suffered chronic daily headaches and about 22 percent of those with “episodic” migraine headaches. By comparison, approximately 8 percent of the population is estimated to have PTSD.

<snip>

“The implications are such that abuse causes not just psychological distress from PTSD but also physical pain such as migraine,” Peterlin said, and there is an increased disability seen in those migraine sufferers with PTSD than those without PTSD.

<snip>

SOURCE: Headache April 2009.
The full article can be found at
http://www.canada.com/news/Post+traumatic+stress+common+migraine+sufferers/1461579/story.html

The Mayo Clinic just issued the following news release:

Mayo Clinic Researchers Examine the Psychological Impact of Child Abuse

SAN FRANCISCO, May 21 — According to a new Mayo Clinic study, a history
of child abuse significantly impacts the wide range of challenges facing
depressed inpatients.

Included are an increase in suicide attempts, prevalence of substance
use disorder, and a higher incidence rate of personality disorder.

Additionally, these victims also had an earlier onset of mental illness
and an increase in psychiatric hospitalizations for psychiatric issues.

The study was presented at the American Psychiatric Association 2009
Annual Meeting in San Francisco.

The impact of child abuse already is known to increase the risk of
suicide; however, the literature about other characteristics of
depressed victims of child abuse is scarce.

Although the findings of the Mayo study do not confirm causality, the
information stresses the importance of more aggressive approaches from
the public health perspective to prevent child abuse.

“A history of child abuse makes most psychiatric illnesses worse,”
according to Magdalena Romanowicz, M.D., lead author of the study.

“We found that it significantly impacts the wide range of
characteristics of depressed inpatients, including increased risk of
suicide attempt, substance abuse, as well as earlier onset of mental
illness and more psychiatric hospitalizations.

This new information serves as a reminder of the importance of child
abuse prevention from a public health perspective.”

Dr. Romanowicz says plans are under way to further examine the
association between child abuse and metal illness in a larger study of
patients.

Other authors of this Mayo Clinic study include: Gen Shinozaki, M.D.;
Victoria Passov, M.D.; Simon Kung, M.D.; Renato Alarcon, M.D.; and David
Mrazek, M.D.

Courtesy of Ken Pope

“The Paradox of Declining Female Happiness.

The authors are Betsey Stevenson & Justin Wolfers.

Here’s the abstract: “By many objective measures the lives of women in
the United States have improved over the past 35 years, yet we show that
measures of subjective well-being indicate that women’s happiness has
declined both absolutely and relative to men.  The paradox of women’s
declining relative well-being is found across various datasets, measures
of subjective well-being, and is pervasive across demographic groups and
industrialized countries.  Relative declines in female happiness have
eroded a gender gap in happiness in which women in the 1970s typically
reported higher subjective well-being than did men.  These declines have
continued and a new gender gap is emerging — one with higher subjective
well-being for men.”

The article is online — but requires a subscription — at:
<http://www.nber.org/papers/w14969>.

Courtesy of Ken Pope

The University of Montreal issued the following news release:

Canadian men reluctant to consult mental health services

University of Montreal study points to prejudice as No. 1 cause

Between 20 and 70 percent of Canadians affected by mental illness shun
medical treatment. Such avoidance of services provided by doctors and
psychologists is particularly acute among men, according to a recent
study published in the Journal of Behavioral Health Services & Research.

In Canada, less than 10 percent of the population utilizes mental health
services for problems ranging from depression to schizophrenia.

But this number isn’t representative of the real number of people
suffering from mental illness, according study author Aline Drapeau, a
researcher at the Université de Montréal’s Department of Psychiatry and
Centre de recherche Fernand-Seguin of the Louis-H. Lafontaine Hospital.

According to data from the Statistics Canada Canadian Community Health
Survey, women are 1.5 times more likely than men to turn to psychiatric
services, twice as likely to consult a psychologist and 2.5 times more
likely to turn to a general practitioner.

While these numbers might suggest that more women suffer from mental
illness, Drapeau disagrees.

“In comparable circumstances, women consult more often than men,” she says.

The discrepancy, says Drapeau, shows how men and women do not perceive
symptoms in the same way as programmed in their social anchorages.

“Social anchorages is an enculturation mechanism by which a person
learns his or her social roles,” says Drapeau.

“Men and women don’t always have the same cultural reference points
because socially acceptable attitudes and behaviors can vary for both sexes.”

For instance, parental obligations aren’t perceived equally in the
workplace. For women, it is perceived as positive to attend to maternal
duties.

For men, forgoing work to take care of the kids is perceived more negatively.

The same parallels exist in mental health. “If mental disease is seen in
a negative light in the workplace, a man will be more reluctant than a
woman to use the services available to treat their disease,” says Drapeau.

Other factors, such as tight finances or even type of employment, can
influence whether men use mental health services.

But the root of the problem, Drapeau stresses, is that men have greater
difficulty acknowledging and accepting their symptoms.

Ken Pope

The *Journal of Epidemiology and Community Health* issued the following
news release:

People with parents who fight are more likely to have mental health
problems in later life

Exposure to interparental violence and psychosocial maladjustment in the
adult life course: Advocacy for early prevention

People with parents who were violent to each other are more likely to
have mental health problems when they grow up, reveals research
published in the Journal of Epidemiology and Community Health.

Researchers looked at what impact interparental violence had on people
as children by observing their mental health outcomes in adulthood.

A child being exposed to interparental violence is a form of
maltreatment with consequences for a child’s development, but in some
countries it is only seen as a risk factor for later problems with no
specific outcomes.

The authors studied 3,023 adults in the Paris metropolitan area in 2005
by carrying out at-home face to face interviews.

People who agreed to take part were found from a population based cohort
study in Paris held by the National Institute of Health and Medical Research.

The researchers measured current depression and lifetime suicide
attempts, intimate partner violence, violence against children and
alcohol dependence.

They also asked people about childhood adversities such as parental
separation, divorce, parental death or imprisonment, alcoholism and
physical and/or sexual abuse, as well as asking about social level
stressors including poor parental health, housing problems, prolonged
parental unemployment, and financial troubles.

Among the group of people interviewed, 16% said they had witnessed
interparental violence before the age of 18 and this was far more common
in certain situations. For example, it was up to eight times more likely
in cases where parents had been alcoholics.

Other factors were also relevant and witnessing violence was more common
in families with financial problems, serious parental diseases, housing
problems or unemployment.

After adjusting for family and social level stressors, the researchers
found that people who were exposed to interparental violence had a 1.4
times higher risk of having depression, were more than three times more
likely to be involved in conjugal violence, were almost five times more
likely to mistreat their own child and 1.75 times more likely to have a
dependence on alcohol.

The authors concluded: “Intensification of prevention of and screening
for domestic violence including interparental violence is a public
health issue for the well-being of future generations.”

Courtesy of Ken Pope

June’s *British Journal of Psychiatry* (vol. 194, #6) includes an
article: “Delayed-onset post-traumatic stress disorder among war
veterans in primary care clinics.”

The authors are B. Christopher Frueh, Anouk L. Grubaugh, Derik E.
Yeager, & Kathryn M. Magruder.

Here’s the abstract:

Background

Only limited empirical data support the existence of delayed-onset post-
traumatic stress disorder (PTSD).

Aims

To expand our understanding of delayed-onset PTSD prevalence and
phenomenology.

Method

A cross-sectional, epidemiological design (n = 747) incorporating
structured interviews to obtain relevant information for analyses in a
multisite study of military veterans.

Results

A small percentage of veterans with identified current PTSD (8.3%,
7/84), current subthreshold PTSD (6.9%, 2/29), and lifetime PTSD only
(5.4%, 2/37) met criteria for delayed onset with PTSD symptoms
initiating more than 6 months after the index trauma. Altogether only
0.4% (3/747) of the entire sample had current PTSD with delayed-onset
symptoms developing more than 1 year after trauma exposure, and no PTSD
symptom onset was reported more than 6 years post-trauma.

Conclusions

Retrospective reports of veterans reveal that delayed-onset PTSD
(current, subthreshold or lifetime) is extremely rare 1 year post-
trauma, and there was no evidence of PTSD symptom onset 6 or more years
after trauma exposure.

Courtesy of Ken Pope

The new issue of *Archives of Pediatric & Adolescent Medicine* (vol.
163, #6, June) includes an article: "Peace of Mind and Sense of Purpose
as Core Existential Issues Among Parents of Children With Cancer."

The authors are Jennifer W. Mack, MD, MPH; Joanne Wolfe, MD, MPH; E.
Francis Cook, ScD; Holcombe E. Grier, MD; Paul D. Cleary, PhD; & Jane C.
Weeks, MD, MSc.

Here are parts of the abstract:

The objective was to evaluate issues experienced by parents of children with cancer and
factors related to parents' ability to find peace of mind.

One hundred ninety-four parents of children with cancer (response rate,
70%) in the first year of cancer treatment were involved.

The main Outcome Measure was the Functional Assessment of Chronic Illness Therapy-Spiritual Well-
being sense of meaning subscale. This taps peace of mind and sense of purpose.

Most parents had a strong sense of purpose, but lacked peace of mind
representing the strongest sense of peace or purpose. Parents had higher
peace of mind scores when they also reported that
they trusted the oncologist's judgment, that the oncologist had disclosed
detailed prognostic information, and that
the oncologist had provided high-quality information about the cancer.
Peace of mind was not associated with prognosis or time since diagnosis.

Conclusions  

Physicians may be able to facilitate formulation of peace of mind by
giving parents high-quality medical information, including prognostic
information, and facilitating parents' trust.

Courtesy of Ken Pope

Ginkgo Biloba May Be an Effective Tool in Treating ADHD

Although psychostimulants have been proven effective in treating certain core symptoms of ADHD, some patients find their side effects intolerable while still others continue to struggle with distractibility, restlessness and irritability.

With a growing literature supporting the effectiveness of herbal products to treat neuropsychiatric illnesses, Dr. Helmut Niederhofer conducted one of the first systematic, open label trials of ginkgo biloba in patients with ADD (aged 17 to 19; N=6). Gingko biloba extract (80 mg dose containing 9.6 mg Ginkgoflavonglycosides) was administered orally three times a day for four weeks. Patients were evaluated at baseline and one month following treatment using the 60-item Wender Utah Rating Scale.

Overall, ginkgo biloba was well tolerated. Two participants reported headache and stomachaches during the first two weeks; symptoms later disappeared for one patient and consisted of mild episodes for the other. Only minimal sedation was reported.

The study found large reductions in Wender scores for fidgeting, disruptive sounds, rigidity and anxiety. The ginkgo appeared to reduce hyperactivity; enhance frustration tolerance and affect modulation; and facilitate voluntary selective processes essential to wilful cognition and discriminant attention.

Based on these promising findings, the researcher believes ginkgo biloba could be an effective alternative and/or a helpful adjunct to psychopharmaceuticals in the treatment of ADHD.

from Psychiatric Times 28 May 09

————–

Note: very small sample, but then again the effects were quite large. BG.

“There is an idea current in the prevailing culture that writing about something that means you heal the pain.  I was not, when I began writing my life story, and I am not now, healed of my mother.  You do gain a small distance from anything by keeping it in suspension in your mind while you work at finding the words to fit it.  The process is so slow and incremental that you do not notice its effect, but the point is that it is a process.  I found out when I was a little girl that if you are crying uncontrollably and want to stop, the thing is to do something useful with your tears — water a plant, say.  They’ll dry up for themselves.  The same happens when you try to make sentences of painful material: the material lightens as it is put to work.”

Nualo O’Faolain in “Almost There”, pg. 36.

From John Gottman “7 Principles that make marriage work”

First – what does not work:  Signs of a marriage in trouble

• A harsh start up — leading off a discussion with criticism and/or sarcasm, a form of contempt.  If your discussion begins with a harsh start up it will inevitably end on a negative note.
• The “four horsemen of the apocalypse” – criticism, contempt, defensiveness, stonewalling strongly predict divorce.
• A complaint focuses on a specific behavior, but criticism ups the ante by throwing in blame and general character assassination — “what’s wrong with you?”
• Contempt includes sarcasm, cynicism, name calling, eye rolling, sneering, mockery, and hostile humor.  It is poisonous to a relationship because it conveys disgust.  It’s virtually impossible to resolve a problem when your partner is getting the message you are disgusted with him or her.  Inevitably, contempt leads to more conflict.
• Defensiveness rarely has the desired effect.  The attacking spouse does not back down or apologize.  This is because defensiveness is really a way of blaming your partner.  You are saying in effect, “the problem is not me, it’s you”.  Defensiveness just escalates the conflict.
• With stonewalling, eventually one partner tunes out.  Rather than confronting his wife, the husband disengages.  By turning away from her, he is avoiding a fight, but he is also avoiding his marriage.  This is far more common among men.  He tends to look away or down without uttering a sound.
• Usually people stonewall as protection against feeling flooded.  You feel so defenseless against the sniper attack you learn to do anything to avoid a replay.
• Recurring episodes of flooding lead to divorce for two reasons.  First they signal that at least one partner feels severe emotional distress.  Second, the sensations of feeling flooded make it almost impossible to have a productive, problem solving discussion.  Your ability to process information is reduced, meaning it’s harder to pay attention to what your partner is saying.  When either partner begins to feel flooded routinely, the relationship is in serious trouble.  Frequently feeling flooded leads almost inevitably to distancing yourself from your spouse.  This in turn leads you to feel lonely.
• Failure of repair attempts (“let’s take a break”, “wait I need to calm down”) to put on the brakes so that flooding is prevented.  When the four Horsemen rule the couples communication, repair attempts often do not even get noticed.  In unhappy marriages, a feedback loop develops between the four Horsemen and the failure of repair attempt.  The more contemptuous and defensive the couple is with each other, the more flooding occurs and the harder it is to hear and respond to a repair attempt.
• In a happy marriage couples tend to look back on the early days fondly.  When a marriage is not going well, history gets rewritten – for the worse.  Or the past is difficult to remember because it has become unimportant or painful.

What does work: the 7 principles Gottman discovered by observing successful couples

• Principle one: enhance your love maps – awareness of your partner’s life and experieinces. Check in with each other often, share lots.
• Principle two: nurture your fondness and admiration. Give messages of appreciation and affection. Focus on the good in your spouse.
• Principle three: turn towards each other instead of away. Make a habit of helping each other cope, turn to each other in times of stress, connect lots.
• Principle four: let your partner influence you. Yield in order to win. Accept influence. Choose “us” over “me”. Compromise.
• Principle five: solve your solvable problems. Do this by raising problems gently and respectfully, make and receive efforts to moderate conflict, sooth self and each other,
  compromise and be tolerant of each other’s faults.
• Principle six: overcome gridlock on unsolvable problems (70% of marital problems never really go away). move from gridlock to dialogue.  Learning to be able to talk about it without hurting each other.  You learn to live with the problem.  You first have to understand its cause.  It is a sign that you have dreams for your life that are not being addressed or respected by each other.
• Principle seven: create shared meaning with shared goals, values, stories, symbols, rituals, and compatible roles in life.

Obviously there is much more to this than a checklist, and Gottman’s book includes many questionnaires for couples to use to study their relationship and identify problem areas along with practical exercises to increase the quality of the relationship using the 7 principles.

Summarized by Brian Grady PhD R.Psych.