Kathi Baker

Stigma and shame block mental health treatment in Black community

As Dr. Sarah Vinson rotated through her first year of clinical work as a Child Psychiatry Fellow in the Department of Psychiatry and Behavioral Sciences at Emory, she quickly became aware that there are some significant roadblocks in getting people in the African-American community engaged in treatment for mental health problems.

Sarah Vinson, MD, Department of Psychiatry and Behavioral Sciences

“Misinformation, an absence of trust in the system, racism and financial circumstances are some of the forces that can create barriers in making appropriate decisions about seeking treatment,” says Vinson.

In order to take a step toward resolving the problem, Vinson created an online mental health outreach program targeting the Black community. The website serves as an anonymous resource for patients and their families, or anyone who is interested in finding out more about mental illness.

This user-friendly online program provides educational materials, offers links to professional organizations, lists mental health professionals and provides descriptions of different types of mental illnesses as they relate specifically to African-Americans. The website also includes an interactive forum where people can share experiences.

“The Black community’s traditional reluctance to discuss mental health and illness comes at much too high a cost,” says Dr. Vinson.

“People may be fearful of being misjudged by their churches and families, so they don’t discuss their problems,” she explains. “However, it is the support of family and friends that is largely responsible for a successful course of treatment; particularly when it comes to children and adolescents, or people with severe mental illness. Regrettably, when people access care without reinforcement from their loved ones, they often drop out before they are better.

“Untreated, mental illness can cause strained relationships, social dysfunction, and numerous other problems that can end up in divorce, unemployment, and suicide.”

Dr. Vinson is the recipient of an American Psychiatric Association/Substance Abuse and Mental Health Services Administration Fellowship, which provides funds for programming related to minority mental health.

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Media’s contribution to stigma

Photo credit: Julia Freeman-Woolpert

Tireless advocacy in the last decade by mental health professionals and people who are affected by mental illness has aimed to reduce the stigma of psychiatric disorders. To determine the influence those efforts have had on news media portrayals, Emory researchers studied newspaper articles using the terms “schizophrenia” and “schizophrenic” in the years 2000 versus 2010.

“The primary goal of journalists is to give fair, accurate and unbiased reports of news events that will be of interest to the public,” says study author Arshya Vahabzadeh, MD, resident psychiatrist in the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine.

Arshya Vahabzadeh, MD, resident psychiatrist in the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine says that people who suffer from a mental illness often internalize negative references, and develop coping mechanisms that become obstacles to treatment.

“A secondary goal is to capture the attention of readers and viewers,” he says. “Unfortunately, stories linked to a mental illness have been shown to strongly attract readers’ attention, and to contribute to unfavorable public conceptions of mental illness.”

According to the researchers, the decade from 2000 to 2010 was of particular importance to the study because as the new millennium began, attention increasingly focused on public awareness of mental illness, with mental health professionals, advocacy groups and governmental bodies targeting de-stigmatization of psychiatric disorders.

Vahabzadeh and his colleagues examined hundreds of articles that appeared in five major newspapers during a five-month time period during 2000 and 2010, searching for the terms “schizophrenia” and “schizophrenic”.

The researchers found that during that period in 2000, 7,114 articles were published in the five selected newspapers, 247 of which mentioned schizophrenia. During the same period in 2010, 4,397 articles were published, with 151 articles mentioning schizophrenia.

Although a larger percentage of the articles were published in 2000 than in 2010, the percentage of articles mentioning schizophrenia did not differ. Similarly, there was no significant difference in metaphorical usage of the term “schizophrenia” – using the term to describe conflicting decisions or illogical actions.

Of particular concern to investigators was that 60 percent of the human-interest stories in both time periods focused on highly emotive reports of violence, dangerousness and criminality. Murders committed by people with schizophrenia accounted for almost half of such articles. The authors did, however, recognize a smaller proportion of articles focusing on crimes and murder committed by people with schizophrenia in 2010 compared to 2000.

Additionally, despite the fact that people with schizophrenia are more prone to be the victims rather than perpetrators of crime, situations in which people with schizophrenia were reported as victims accounted for only 0.5% of the articles reviewed.

“People who suffer from a mental illness often internalize these negative references, and develop coping mechanisms that become obstacles to treatment,” explains Vahabzadeh.

“Negative perceptions also may result in problems for those who are successfully treated,” he says. “People with schizophrenia may encounter stigma when they attempt to integrate into society, build relationships, find employment and even housing. It is important for us as mental health professionals to look for opportunities to educate the media on ways to become a positive force to reduce stigma.”

Nadine Kaslow, PhD, professor and chief psychologist at the Emory University School of Medicine, whose mentorship inspired the study, says “This study provides invaluable information about the persistence of negative and unfounded portrayals of people living with schizophrenia to the public. It is imperative that everyone interacts with people living with mental illness respectfully and with compassion, and that they be welcomed members of our community.”

The study was published in the Journal of Psychiatric Practice http://www.ncbi.nlm.nih.gov/pubmed/22108403.

Additional study investigators include Justine Wittenauer, MD, Emory University School of Medicine and Erika Carr, PhD, Yale University School of Medicine.

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Sunscreen: Looking Beyond the Numbers

Carl Washington, MD

Seems pretty obvious – if a sunscreen with an SPF of 30 is good, then an SPF of 100 should be at least three times as good.

Unfortunately, that is not the case.  There are other important details to consider when you are purchasing a sunscreen.

“People have become much more educated about the importance of using sunscreen, and manufacturers have responded with an abundance of products,” says Carl Washington, MD, associate professor of Dermatology at Emory University School of Medicine. “Unfortunately, the labeling can be confusing and many of the current sunscreens only contain the ingredients necessary to offer protection against sunburn, but not skin cancer or aging.”

Recently, the Food and Drug Administration created new regulations to establish standards for sunscreen manufacturers to follow before they label their products.

Under the new regulations, which will go into effect in 2012, sunscreen products that protect against all types of sun-induced skin damage will be labeled “broad spectrum” and “SPF 15” or higher on the container. Only products that have been tested to ensure they protect against both UVA (ultraviolet radiation A) and UVB (ultraviolet radiation B) radiation will be allowed to use this labeling.  Broad-spectrum sunscreens of SPF 15 and higher can also be labeled as protective against skin cancer and premature aging. The maximum SPF value is set at 50-plus because the FDA says anything higher doesn’t provide a significant amount of additional protection.

Manufacturers will have to include warning labels on products that are not broad spectrum. Products that claim to be water resistant must indicate how long the consumer should expect to be protected in the water, and using such language as “waterproof” or “sweat proof” will not be allowed.

“Skin cancer is the most common form of cancer in the United States, and the number of people affected keeps rising. Simply getting into the habit of using a sunscreen every day – with the appropriate levels of protection – can make a significant difference in preventing many skin cancers, as well as premature aging,” says Washington.

“These new regulations will help consumers understand the difference in degrees of sun protection, and choose carefully.”

Washington also suggests staying out of direct sunlight between 10 am and 2 pm, seeking shade when you are outdoors, remembering to reapply sunscreen every two hours and wearing protective clothing.

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When veterans face emotional trauma

Emory researcher Barbara Rothbaum, PhD, professor of psychiatry and behavioral sciences, Emory School of Medicine,  and director of the Trauma and Anxiety Recovery Program, has been treating military personnel with posttraumatic stress disorder (PTSD) for more than a decade, helping them to learn how to deal with troubling memories. Through therapy, the service members are taught that by re-living the traumatic event, they can begin to learn how to control the effect those memories have when they surface.

Barbara Rothbaum, PhD, demonstrating virtual reality exposure therapy used to help veterans with PTSD.

PTSD is treatable and treatments vary from exposure therapy to medication to meditation techniques. Symptoms include reliving the event; avoiding situations that stir up memories of the event; discomfort expressing feelings; being constantly on the lookout for danger; irritability; drinking or drug problems; and employment, social and relationship problems.

Many times it’s the family members, friends or co-workers who are first to identify a change in the veteran or service member. Symptoms can arise abruptly and begin to interfere with every day activities. When those symptoms last for more than four weeks, it is likely that individual has posttraumatic stress disorder (PTSD).

Rothbaum emphasizes that treatment for PTSD is very effective.  She encourages active duty military personnel, veterans and others who have been exposed to trauma to seek diagnosis and treatment for problems that persist.  Symptoms can worsen with time, or cause social and employment problems that complicate recovery, but treatment can help.

More information on PTSD is available from the U.S. Department of Veterans Affairs. A clinical trial taking place at Emory uses virtual reality therapy for military personnel who have served in Iraq and Afghanistan and have been diagnosed with PTSD.

Emory PTSD research by Dr. Rothbaum and her colleagues is featured on GE’s Healthymagination website.

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Anticipating approval from a renowned scholar

Charles Raison, MD, with the Dalai Lama

When Charles Raison hosted a fundraising dinner for Jestun Pema, the sister of His Holiness the Dalai Lama some years ago as a faculty member at the University of California at Los Angeles, little did he know his future would become intertwined with His Holiness.

Raison, who is a psychiatrist and an associate professor in the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine, began his career at Emory in 1999. Since that time, he has emerged as one of the leaders in Emory’s remarkable relationship with the Dalai Lama through the Emory Tibet Science Initiative (ETSI) and his research on the potential health benefits of compassion meditation.

The Dalai Lama recently visited Emory in his role as Emory Presidential Distinguished Professor and presided over a series of conferences related to ETSI.  Raison made a presentation to His Holiness during the Compassion Meditation Conference.

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A concussion is more than just a headache

 

Ken Mautner, MD

To ensure better management of sports concussions, physicians at Emory Sports Medicine Center have incorporated Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) into their program for high school athletes.

 

Concussions occur in about 10 percent of all athletes in contact sports.

They are caused by sudden and violent rocking of the brain inside the skull from a traumatic blow to the head or upper body.

Symptoms vary in length of time and may include amnesia, disorientation, confusion, fogginess, headache, blurred vision, nausea, fatigue and sometimes loss of consciousness.

Ken Mautner, MD, sports medicine physician and assistant professor in the Department of Orthopaedics at Emory University School of Medicine, says that most athletes recover completely from concussions as long as they are not returned back to play too soon.

Repeated concussions are cumulative and may cause critical damage to the brain.  Studies have indicated a possible association with frequent or untreated concussions and development of dementia, depression and, most recently, ALS (Lou Gehrig’s Disease).  Going back to the sport too soon, before the brain recovers, leaves athletes vulnerable to repeat concussions.

Athletes in the ImPACT program take a 20-minuted baseline test on a computer that measures brain processing such as speed, memory, and visual motor skills.

Each individual’s data are stored in a computer file. In the event of injury, the athlete will take the ImPACT test in the days following concussion.  Post-concussion data are then compared to baseline data to help determine the severity and effects of the injury.

Mautner says that data from ImPACT combined with a thorough history and physical exam is the best way to prevent athletes from getting “back in the game” too soon.

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New technology enables precision in jaw reconstruction

Steven Roser, MD

When people have misaligned jaws where the upper and lower teeth don’t match, the functional impact ranges from articulation and speech problems to problems with eating.

When jaw reconstruction is required, the outcome must be precise. The way people eat and bite is a very sensitive mechanism, and teeth have to meet in a certain way in order to bite and chew correctly.

Planning the surgery is the key.

A new system being used by Emory oral and maxillofacial surgeons helps them reach a level of preoperative planning that they had not been able to achieve before.

The system takes data from the patient obtained through CT scan (Computed Tomography) and optical scanning, and puts it into a software program that has been developed to allow the surgery to be performed virtually on the computer. This preoperative planning assists in the construction of an accurate intra-operative guide.

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Survivors of intimate partner violence find safety, hope and purpose

Nadine Kaslow, PhD

Nadine Kaslow, PhD, Emory psychologist and professor in the Department of Psychiatry and Behavioral Sciences at Emory, has learned a lot about Intimate Partner Violence (IPV) over the last two decades. In the 1990’s, Kaslow began the development of a program that was eventually named the “Nia Project.”

Nia is a counseling program for abused and suicidal African American women, funded by grants from the Centers for Disease Control and Prevention (CDC) and the National Institute of Mental Health. The name comes from the Kwanzaa term that means “purpose.”

Nia serves countless numbers of abused and suicidal women who come through Atlanta’s Grady Memorial Hospital’s emergency department each year. The women come in with black eyes, broken bones, and broken spirits, often inflicted by the people who are supposed to love them the most: their husbands, boyfriends and partners.

According to the CDC, Intimate Partner violence resulted in more than 1,500 deaths in the United States in 2005.  Statistics from the Commission on Domestic Violence show that African American females experienced intimate partner violence at a rate 35 percent higher than that of white females, and about 22 times the rate of women of other races. The number one killer of African American women ages 15 to 34 is homicide at the hands of a current or former intimate partner.

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Sports medicine advances reach the masses

Drawing of the knee, courtesy of the National Institute of Arthritis and Musculoskeletal and Skin Diseases

An anterior cruciate ligament, or ACL, tear is one of the most common sports injuries, especially in sports that require running, jumping or pivoting movements.

Akin to a fibrous, thick rubber band made of collagen, the ACL runs through the center of the knee and connects the femur to the tibia, allowing the knee to bend and flex—but not too far. When it tears, the knee can become destabilized. So, for anyone who wants to continue to play sports, surgery is required.

Once a narrow subspecialty of orthopaedics with a focus on professional athletes, the field of sports medicine has exploded in the last decade. The evolution of ACL surgery is just one of several advances in the treatment of athletes and their injuries that have started to serve not only the pros who make a living from their skills, but also the weekend warrior.

This may include individuals who get hurt in the heat of a pick-up game, the neighborhood league player with tennis elbow, the college runner who pulls a tendon, or the high school football player with a possible concussion.
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Nia Project: Helping victims of violence

Nadine Kaslow, PhD, Emory School of Medicine professor of psychiatry and behavioral sciences, founded in the early 1990s the Grady Nia Project for abused and suicidal African-American women. Named for the Kwanzaa term that means “purpose,” Nia serves countless numbers of abused women who come through Grady Memorial Hospital’s emergency department each year.

The program is funded by grants from the Centers for Disease Control and Prevention and the National Institute of Mental Health, and Kaslow serves as principal investigator. Kaslow also serves as chief psychologist at Grady Memorial Hospital and holds a joint appointment in the Departments of Psychology, Pediatrics and Emergency Medicine, and the Rollins School of Public Health.

Nadine Kaslow, PhD

Kaslow says the women in the Nia program, who either feel suicidal or have attempted suicide because of stress associated with violence, are victims of intimate partner violence and are usually black, minimally employed, with children and addicted to drugs and alcohol. Many are homeless.

Nia is staffed 24/7. Some staffers may make a trip to the emergency department in the middle of the night when a woman comes in with injuries or a story consistent with intimate partner violence or when she has attempted suicide. If a woman enrolls in the program, she will join approximately 50 to 75 other women who are going through it at any given time.

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