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Scan casts new light on neurobiology of borderline personality disorder The Menninger Clinic specializes in the treatment of Borderline Personality Disorder (BPD) through several techniques including mentalizing. Members of the media wishing to speak to a Menninger expert on either BPD or mentalizing may contact Sue-Ella Mueller, media relations specialist, at 281-300-0197 or smueller@menninger.edu. The Menninger Clinic ranks sixth in national survey
About The Menninger Clinic
“We are the first free standing psychiatric hospital to receive this designation,” says Pam Greene, PhD, RN, vice president of Patient Care Services at Menninger. “To be recognized on the national level for our commitment to supporting nurses as they provide safe, quality patient care is an honor.” Menninger achieved the Texas Nurse-Friendly designation from the Texas Nurses Association (TNA) in 2007. TNA recently transferred the designation program to the ANCC and the name was changed to Pathway to Excellence. “We are thrilled to be recognized as a Pathway to Excellence facility,” said Greene. “We’ll continue to ensure that, through our shared governance environment, we create a culture that is desirable and supportive of our nurses.” Pathway to Excellence About The Menninger Clinic Dr. Edythe Harvey named medical director on Hope Program Before coming to Menninger as a staff psychiatrist in 2006, Dr. Harvey was medical director of the psychiatric emergency center at A graduate of The University of Texas at “I’m excited about my new position with Menninger,” said Dr. Harvey. “Hope has a great staff and the patients are wonderful. I am also looking forward to helping with the transition from our current location to the new facility in 2010.” The Menninger Clinic is in the midst of a capital campaign to build the first international epicenter for mental health. The new location will encompass 50 acres in southwest About The Menninger Clinic Making peace with your college student “Often when young adults come home for their first extended leave from college, there can be some conflict in the family,” says Heather Stewart, LCSW, a social worker and primary clinician at The Menninger Clinic. “Roles have changed while the young adult has been away at school. The young adult has had a sense of becoming a true adult. They’ve tested the waters on their own and have set new boundaries like self-inflicted curfews. Where the conflict comes in to play is when these boundaries are not completely in line with the parents’ wants.” Stewart says some parents may struggle with still wanting to provide structure for the child and maintain the control in the relationship. At the onset of summer, many parents have preconceived notions of reverting back to the way things were when their child was in high school. However, the young adult may feel stifled by the attention. They have spent the last few months gaining independence and moving towards adulthood. “A parent may see the young adult staying up late and they are worried that their child is not getting enough sleep. Or perhaps the young adult is taking full advantage of the summer break and is just lying around the house during the day. It can be frustrating for a parent,” says Stewart. One suggestion Stewart has for parents is to set up a meeting before things get out of control. “The best time for the meeting to take place is at the beginning of the summer before there is ever even a problem,” she says. “However, it’s never too late to sit down together and talk about expectations for the remainder of the summer; just make sure you schedule the meeting and that it doesn’t take place during the heat of an argument.” Stewart encourages both parties to put some thought into what outcomes they would like to see take place. She says that parents need to come up with their game plan and what they want accomplished. Things to consider may include the following:
“Opening the dialogue with something like ‘this is what I’m seeing and this is why I’m concerned,’ may give the young adult a clearer understanding of the parents’ feelings,” Stewart said. “In return, let them know you are not trying to control them but are working to support them on this journey of independence and responsibility.” Stewart says it is important for a young adult to take into account that their parents’ have their own lives. Be prepared to compromise on issues such as curfews, realizing that on weeknights, parents are obligated to get up the next morning and go to work. “If the young adult wants to be seen as an adult, they need to be willing to take the necessary steps toward proving their maturity to parents,” said Stewart. A few suggestions for a young adult to keep in mind:
“Volunteering can have tremendous benefits for the young adult,” Stewart says. “It can help you connect socially with others, taking you out of your element and giving you exposure to a different side of life.” The family meeting will be a time to discuss these ideas. The biggest pitfall to families, Stewart says, is if the meeting turns into a power struggle. If that becomes the case, she suggests involving a third party such as a family friend. A therapist may also need to be brought in for conflicts that just can’t seem to be resolved. “This is a time of transition for everyone and it can be difficult,” says Stewart. “But it should also be a time of excitement. You are getting to experience your child in a whole new way. They’re just beginning to spread their wings. Acknowledge this change, this shift to adulthood and choose to celebrate it.” About The Menninger Clinic Connie Menninger dies at age 76 [1931-2008] Conference delves into new research and treatment of borderline personality disorder Borderline personality disorder (BPD), characterized by pervasive instability in moods, interpersonal relationships, self-image and behavior, afflicts approximately 2 percent of the general population and is a leading cause of suicide. Eight to 10 percent of individuals with this disorder take their own lives. “A common misapprehension by family, friends and often by clinicians is that patients with borderline personality disorder are not likely to commit suicide since suicidal behavior is seen as a bid for attention, misjudged as not serious. The prevalence is more than 400 times higher than in the general population,” said John Oldham, MD, MS, senior vice president and chief of staff, The Menninger Clinic, and professor of psychiatry and executive vice chair, Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine. Despite the prevalence of BPD, its diagnosis by therapists is often impeded by the lack of awareness and frequent co-occurrence with other conditions, such as depression, substance abuse and anxiety. To help therapists diagnose this disorder and build an alliance with their BPD patients, new ways of categorizing and defining BPD are in consideration. Dr. Oldham is one of the consultants on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), expected to be published in 2011. BPD usually manifests itself in late adolescence or early adulthood, according to Dr. Oldham. “Patients with borderline personality disorder often have a stormy course, punctuated with episodes of high-risk behavior. The patient’s symptom profile as well as coexisting conditions, such as substance abuse, influence an individual’s course. Due to the disabling nature of the disorder, accompanied by high levels of emotional pain and distress, patients generally seek treatment and if they adhere to treatment and overcome high-risk behavior, they may ultimately do quite well.” Officially recognized in 1980 by the psychiatric community, borderline personality disorder is at least two decades behind in research treatment options and education compared to other serious mental illnesses. Congressional Resolution, H. Res. 1005, is awaiting final action to designate May as Borderline Personality Disorder Awareness Month. This resolution acknowledges the pressing burden of those afflicted with borderline personality disorder, confirms the widespread prevalence of this disorder and seeks to spread awareness of this under-recognized and often misunderstood mental illness. This Menninger Continuing Education Conference, offering continuing education credit to health professionals, is co-sponsored by the National Education Alliance for Borderline Personality Disorder (NEA-BPD) and The National Alliance on Mental Illness (NAMI) Metropolitan Houston. Topics and speakers include:
For the conference schedule or registration call Menninger Education at 713-275-5060. The Menninger Clinic is an international specialty psychiatric center, providing treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to New book explores key to healthy relationships and self-awareness Peers reviewing the book recognize mentalizing’s potential for shaping mental healthcare:
Mentalizing in Clinical Practice is now available from American Psychiatric Publishing Inc. To order, visit: appi.org. The Menninger Clinic is an international specialty psychiatric center, providing treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to Overcoming an eating disorder: a glimpse into one woman’s journey Cynthia Nelson, a 31-year-old Houstonian, understands the impact of eating disorders. She struggled with anorexia nervosa for 11 years and says she still battles negative thoughts about her size almost daily. Nationally recognized experts will discuss eating disorders treatment at the 2008 Eating Disorders Conference of Houston: Perspectives on Treatment and Prevention, on Friday, February 22, at the “Negative self-image is one of the most difficult things to change when treating an eating disorder and is the last symptom to resolve from treatment,” says Theresa Fassihi, PhD, a psychologist with the Eating Disorders Program at The Menninger Clinic, who will be presenting at the conference on self-image and the risk for relapse. “If a patient does not make some improvement on body image issues early in treatment, it is a significant risk factor for relapse into the eating disorder.” Cynthia attests to the difficulty of reaching the decision to “give up your eating disorder” in order to get on the road to a healthy weight and eventually, recovery. Cynthia explains that her eating disorder became such a part of her identity that the thought of giving it up seemed impossible. At age 17, when Cynthia was first diagnosed with anorexia, her eating disorder began to rule her life. As a perfectionist, being skinny became her way of trying to feel good enough at something, please everyone and eventually became her primary focus. “Being from an affluent area where everything is important, from your grades to how you look, I remember being self-conscious about my body beginning in junior high school,” says Cynthia. “My junior year is when I remember noticing models on TV and in magazines and thinking how great it would be if I looked like them. I started losing weight to look better and to be accepted by everyone. Eventually it was the only thing I could think about.” During her senior year in high school, Cynthia’s eating disorder escalated to the point her parents decided to find an outpatient treatment program for her. Because the eating disorder had consumed her entire identity, Cynthia didn’t care to engage in treatment. She was eventually hospitalized and fed through a feeding tube. Although she was close to dying, all she cared about was losing weight. She was stabilized enough to enter a treatment center specifically for people struggling with eating disorders. That is where she learned about anorexia and the underlying reasons for why she was starving herself. Treatment professionals helped Cynthia learn how to make use of therapy and gain weight. It would take 10 more years of therapy followed by relapses and several more hospitalizations for Cynthia to struggle through giving up, one piece at a time, the eating disorder that defined her. According to Dr. Fassihi, “on average, it takes three to seven years for people with eating disorders to fully recover and lapses or relapses are a common part of the process. With treatment and hard work, up to 90 percent of people with eating disorders can fully recover.” “I experienced a lot of self-hatred, mostly because I never thought I lost enough weight,” Cynthia explains. “My sister and friends didn’t like to go to the mall with me because the entire time I would compare myself to others, constantly afraid there was someone skinnier than me.” Cynthia counts her blessings that her family did not give up on her. She said it wasn’t easy for them. “It was difficult for my younger sister, who was afraid I was going to die. Plus, there was some denial from my family at first, but they got through that and learned how to offer support for someone with an eating disorder, which was critical during the long recovery process.” During her last hospitalization, Cynthia achieved a normal weight and has been able to maintain her weight for the past five years. Cynthia continues to see a therapist and dietitian to help her stay on track. She said her obsession with body image remains a challenging part of her life, but she is determined not to miss out on anything else in life like she did when her life was consumed by anorexia. Although Cynthia had to wait a year after high school to go to college, because of her struggles with anorexia, she was able to complete an undergraduate degree in philosophy and biology and obtain a master’s degree in public health. She is currently enrolled in a master of science physician assistant program. Upon graduating, she plans to work in pediatrics and clinical research. She believes the most important message she can convey to parents and families of people with eating disorders is to catch the signs of the disease early. Eating disorders experts agree, people with eating disorders have a better chance of recovering if they enter treatment within the first six months of any signs of an eating disorder. “Early intervention offers the best prognosis for recovery, and recovery tends to happen more quickly because the behaviors are not as entrenched,” says Dr. Fassihi. Additional topics to be covered at the Eating Disorders Conference of Houston include the prevention of eating disorders and obesity in children. In the More about the conference and speakers can be found at http://www.menningerclinic.com/calendar/EatingDisordersConf.pdf. The conference is underwritten by the Stanford and Joan Alexander Foundation of For more information, call Menninger at 713-275-5060. The Menninger Clinic is an international specialty psychiatric center, providing treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to For interviews with Cynthia or other persons recovering from eating disorders, call Shelli Manning at 713-275-5031 or e-mail smanning@menninger.edu. Help your teen through a breakup “Some relationships may seem so intense and so necessary that teenagers harm themselves when the relationship ends,” says Norma Clarke, MD, a child psychiatrist at The Menninger Clinic and medical director of The Clinic’s Adolescent Treatment Program. Dr. Clarke says she has treated patients who have attempted suicide, cut themselves and abused alcohol or drugs because they have trouble dealing with a breakup. An argument with a boyfriend or girlfriend is the second most common reason that teens attempt suicide, according to an A breakup signals to parents to be alert for signs of trouble in their teen’s emotional health, because they often keep their feelings secret. “If your teen falls off the deep end and you have a sense that you are losing control of him or her, you need to intervene,” says Dr. Clarke, also an assistant professor in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine. Sudden changes in your teen’s behavior may also be signs that he or she is having relationship problems, she adds. Signs a relationship have gone too far
What parents can do
“Parents tend not to talk to kids about relationships or sexual behavior,” Dr. Clarke says. “Keeping an open line of communication about friends of all types, activities and expectations is more welcomed by your child than may be apparent. I don’t think parents realize the impact they have on their teenager’s behavior.” The Menninger Clinic is an international specialty psychiatric center, providing treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to
“Negative self-image is one of the most difficult things to change when treating an eating disorder and is the last symptom to resolve from treatment,” says Theresa Fassihi, PhD, a psychologist with the Eating Disorders Program at The Menninger Clinic, who will be presenting at the conference on self-image and risk for relapse. The conference, open to health professionals for continuing education credit as well as families and the public, kicks off National Eating Disorders Awareness Week, February 24 to March 1. Additional topics covered at the conference will include the prevention of eating disorders and obesity in children. In the Award-winning author and eating disorders expert Margo Maine, PhD, will deliver the 9 am keynote address, titled, “What’s Age Got to Do With It? Adult Women, Eating Disorders & Body Image Despair.” Dr. Leslie Goldman, noted health writer and author of Locker Room Diaries: The Naked Truth About Women, Body Image and Re-imagining the ‘Perfect’ Body, will deliver the noon luncheon presentation. Goldman will share her personal experience with anorexia and her success after medication and therapy, and stories about the women she interviewed for her book. The conference will feature a panel discussion at 1:30 pm on prevention of eating disorders. Panelists include:
Between sessions, conference attendees may also view informational exhibits on eating disorders, including interactive exhibits on self-image, and obtain information about treatment resources. The conference is underwritten by the Stanford and Joan Alexander Foundation of The conference schedule and online registration form are accessible at: MenningerClinic.com, HPAonline.org; HAMFT.org and MHAHouston.org. For more information, call Menninger at 713-275-5060. The Menninger Clinic is an international specialty psychiatric center, providing treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to
Don’t:
If you suspect someone at your dinner or party has an eating disorder, talk to that person at a later time about your concerns, Dr. Fassihi says. Encourage him or her to see an eating disorder specialist to be evaluated for an eating disorder. If your friend or loved one denies a problem, emphasize the tremendous health risks of eating disorders, especially heart problems, permanent bone loss and death. Early intervention offers people with eating disorders the best prognosis.
The Menninger Clinic unveils plans for Mental Health Epicenter;
Menninger’s Miracles in Mind campaign has raised $69.3 million, and is more than half way to its goal of $125 million. $65.8 million will go toward building the first phase of The Clinic’s new campus. $3.5 million will benefit treatment, research and education programs. Construction on The Epicenter is expected to begin in fall 2008, with a target completion date of summer 2010. “The Epicenter will be a beacon of hope to persons suffering from mental illness and the people who love them,” says Ian Aitken, Menninger CEO and president. “Thanks to the generosity of our supporters, we will achieve our goal to improve mental health worldwide, prevent mental illness and eliminate stigma.” One in five Americans suffers from mental illness. The Menninger Mental Health Epicenter will provide much-needed mental health services for the Research and treatment priorities for The Clinic will include: substance abuse and addictions, personality disorders, mood disorders, anxiety and obsessive-compulsive disorders, trauma-related disorders and neuropsychiatric disorders. The Clinic will also continue to offer comprehensive diagnostic assessments for persons who have complicated symptoms or desire a second opinion. Menninger’s collaboration with “The Epicenter will help advance Houston as a center for excellence in mental health treatment, education and research and to continue to attract leading scientists and clinical specialists to Houston,” says Stuart Yudofsky, MD, D.C. and Irene Ellwood Professor and chairman of the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine, and chairman of Psychiatry at The Methodist Hospital. “By encouraging collaboration across disciplines, The Epicenter will be a catalyst for exciting new discoveries about the brain and behavior.” The Epicenter will significantly increase the number of mental health professionals Menninger will train to help alleviate shortages locally and nationally. Educating the public about mental health and effectiveness of treatments for mental illness will also be a major focus of The Epicenter, helping to erase the stigma that prevents many people from seeking treatment. Plans for Phase I of The Epicenter include a 144-bed inpatient specialty psychiatric hospital, a brain and behavior research center, administrative buildings, educational facilities, wellness center, nondenominational chapel, dining center and features including meditation and sculpture gardens. The Clinic will cover approximately half of the 50-acre campus. Phase II building plans include facilities for aftercare services for patients, headquarters for mental health organizations, training and education, and an international leadership program. The Menninger Clinic is an international specialty psychiatric center, providing treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to Psychiatric problems in teens difficult to pinpoint Does he have a learning disability? Depression? Or maybe he’s just a normal teen? Pinpointing a diagnosis of psychiatric and behavioral problems in teens can be tricky, even for experts in mental health. The human brain is still developing during adolescence, and as any parent of a teen can attest, mood and behavior can fluctuate wildly at this age. “Teens are by nature secretive and it is sometimes very hard to figure out what is normal and what is not about teen behavior,” says Norma Clarke, MD, medical director of the Adolescent Treatment Program at The Menninger Clinic in Houston. “Also, teens can behave very well in a psychologist’s or counselor’s office, which makes it harder to arrive at a diagnosis.” That’s the first challenge, Dr. Clarke adds, because an accurate diagnosis is an essential step in treating mental illness. For teens struggling with psychiatric or behavioral disorders it can mean the difference between progressing in treatment or remaining stuck in their current situation and often unhealthy pattern. By adolescence, many teens in treatment for behavioral or psychiatric issues have received multiple diagnoses—ranging from ADHD to bipolar disorder. Mood swings and irritability are a common symptom of many disorders, but, depending on the diagnosis, treatment can be drastically different, including the medication and therapy prescribed. When individuals don’t respond to treatment that is not suited for them, they feel like failures. “They feel that they are broken for life,” Dr. Clarke says. “They feel hopeless and think there is something so wrong with them. It affects their self-esteem and their ability to make friends and become the best they can be.” Many parents of teens struggling with psychiatric or behavioral disorders feel helpless because they can’t help their child, Dr. Clarke adds. Menninger recently launched its Adolescent Assessment Program to provide troubled teens and their parents with more clarity around the problems and issues confronting teens. An accurate diagnosis is one aspect of this clarification. While brief, the two-week evaluation is intense and allows the patient, parents and treatment team to get to the heart of the matter. The Program fits the needs of teens and families who aren’t making progress in their treatment and who desire a second opinion. During their two week assessment at Menninger, patients meet with members of the evaluation team, which includes a psychiatrist, psychologist, internist, social worker, rehabilitation specialist, addictions counselor, nursing and senior staff specialists. The treatment team considers patient and family history, parent and patient reports, psychological testing, past treatment records and observations during the patient’s stay. The Program also uses neuropsychiatric diagnostic tools including magnetic resonance imaging (MRI), to pinpoint the possible causes of behavioral and psychiatric problems in patients and rule out an underlying medical condition, such as a brain injury. Patients participate in individual, group and family therapies and learn about coping strategies. Mental health professionals also review medications and other prescribed interventions. Close to the end of the assessment period, team members share their findings during a conference and discuss the patient's diagnoses and treatment goals. Following this conference, the team shares these findings with the adolescent and the parents and involves them in discussing options for next steps in the treatment process and ways to support the teen academically and socially. Patients may continue treatment at Menninger or other programs if indicated. Armed with answers, teens and parents can make decisions about future treatment methods, schooling and life. With their newfound clarity, they also regain hope. “Once they are pointed in the right direction, teens can make positive strides toward recovery and learn how to lead successful lives,” Dr. Clarke says. The Menninger Clinic is an international specialty psychiatric center, providing treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to Self-injury not limited to teens “Stereotypically people think that self-injury happens only among teenagers and young women, but it also happens with older, middle-aged females and males,” says Harrell Woodson, PhD, director of the Menninger Hope Program, which treats adults with mental illness. The Program is participating in a Clinic-wide initiative to learn more about self-injury and to develop new protocols to treat it, since it is a frequent health issue among Menninger patients. Older patients who injure themselves—commonly by cutting or burning the skin, or banging their heads repeatedly against the wall—are more difficult to treat, Dr. Woodson says. They may have been injuring themselves for such a long time that the behavior has become deeply ingrained. Self-injury can be a sign of a psychiatric disorder, and is common among persons suffering from severe borderline personality disorder, depression or psychosis. While the number of adults who purposely injure themselves is unknown, the behavior may be underreported because many persons who self-injure hide it from others. Left untreated, self-injury and the mental illness that often accompanies it can become dangerous. While most persons who self-injure are not attempting suicide, they may accidentally kill themselves if their behavior goes too far. “Self-injurious behavior can cause irreparable physical damage and can even lead to death, from cutting too deeply, getting an infection or going into shock,” Dr. Woodson says. Why would adults want to hurt themselves?
Treatment Instead, mental health professionals work together with patients to determine how motivated they are to stop their self-injurious behavior. The desire for behavior change needs to come from the patient rather than as a demand from the mental health professional or family members, Dr. Woodson says. Motivational interviewing techniques put the majority of the responsibility for behavior change in the hands of the patient. “With motivational interviewing, you capitalize on the patient’s ambivalence—in terms of the pros and cons of continuing that behavior, in a non-confrontational way,” Dr. Woodson continues. “Traditionally, admonishing people about the consequences of self-injurious behavior doesn’t work very well.” The treatment team on Hope works with patients to discover what triggers a person to self-injure and to develop alternative coping strategies meaningful to that person. One alternative some mental health professionals suggest is to have patients place a rubber band around their arms. Snapping the rubber band creates some pain but no lasting injury. Treatment may also include medication, especially when self-injurious behavior is tied to psychosis, and group therapy. Patients in group therapy discuss what they could do differently in response to particular stressors, situations, thoughts and feelings rather than harming themselves. Groups are an effective form of treatment for self-injury, Dr. Woodson says, because patients learn new insights and adaptive behaviors from their peers as well as receiving support and encouragement. The Menninger Clinic is an international specialty psychiatric center, providing treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to High-tech diagnosis yields vital clues into mental illness “Even though a patient may have a straightforward mental health diagnosis or diagnoses, the neuropsychiatric approach can help us rule out medical or neurological reasons for the patient’s symptoms before we settle on a psychiatric reason,” says Florence Kim, MD, director of the Menninger Comprehensive Psychiatric Assessment Service. Launched in April, the Assessment Service provides adults who have behavioral and psychiatric issues with a thorough two-week assessment, including extensive neuropsychiatric testing. The service is designed as one stop for thorough assessment for individuals who are not making adequate progress in other treatment settings, desire a second opinion, require a thorough psychiatric assessment to determine what treatment program may fit their needs or who were referred by their clinician. Patients in the program also undergo a psychiatric evaluation, extensive neuropsychological testing, psychological testing, psychosocial evaluation, a family system study and a neurological consult. Menninger’s affiliation with Baylor College of Medicine provides patients with access to consultants in neuropsychology and neurology for help with brain disorders such as stroke, Alzheimer's disease, multiple sclerosis and traumatic brain injury. The Assessment Service also offers genotyping for patients who don’t respond well to psychiatric medications. A simple blood test can reveal whether a patient may metabolize a drug too fast, which provides the patient with little benefit, or metabolizes the drug too slowly, which can increase the amount of drug that builds up in the body, causing side effects such as nausea. Currently, doctors prescribe psychiatric medications based on their experience of what works best, but they can’t predict how medications will work in each individual patient. As a result, patients may spend several months or years trying to find the best medication with the fewest side effects. The battery of tests used in the assessment yields a wealth of information, providing unique insight into the patient’s mental and behavioral health, in addition to the patient’s personal history. In some cases, the information may reveal an underlying medical condition, such as dementia or damage caused by a brain injury. It may also help better diagnose the type and the severity of mental illness or behavioral disorder the patient may have. The evaluation looks at all facets of a patient’s life and clinical picture before making treatment recommendations. “One of our recent patients, an 18-year-old, came into the program as result of an intervention,” Dr. Kim says. “He had been labeled with a diagnosis, but as a result of our examinations, we were able to clarify that diagnosis. He told us, ‘finally, someone understands what’s going on.’” As a result of his assessment, the patient changed his plans and immediately sought treatment. At the end of a two- to three- week evaluation, the assessment team provides patients with findings and recommendations for their next steps. About half of patients choose to remain at Menninger for their treatment. Patients may also use the assessment to help guide their treatment at other psychiatric facilities, or outpatient treatment. Dr. Kim sees the Assessment Service as an increasingly valuable tool to diagnosis and treat patients with psychiatric disorders. “We are at the beginning of a new age in terms of what we can do for people with psychiatric illnesses,” she says. “In the next 20 to 30 years, we are going to see an explosion in brain research, and we’ll understand so much more about the genetic basis for many conditions. It’s a very exciting time.” The Menninger Clinic is an international specialty psychiatric center, providing innovative programs in treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to The Menninger Clinic ranks 7th in national survey of best psychiatric hospitals Psychiatric hospital ratings are based on the cumulative results of board-certified psychiatrists surveyed in 2005, 2006 and 2007. The psychiatrists were asked to list the five psychiatric hospitals in the Menninger’s six inpatient programs and two diagnostic services specialize in treating adolescents and adults who have a difficult-to-treat psychiatric disorder that may also be complicated by an addiction or other co-occurring psychiatric disorders. The Clinic also operates active research and education programs through its affiliation with Baylor College of Medicine in “Consistently ranking among the best psychiatric hospitals in the country is especially gratifying, because it validates the high quality of care we provide to persons with serious mental illness,” said Ian Aitken, Menninger president and CEO. “Menninger will continue to build on our more than 82-year legacy as a leader in mental health and develop new advancements in mental health research and treatment that will benefit patients.” A complete list of rankings is available from U.S. News & World Report. The Menninger Clinic is an international specialty psychiatric center, providing innovative programs in treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to Painkiller abuse continues to grow; new treatments offer hope More than 6 million Americans abuse prescription drugs, according to the U.S. Drug Enforcement Administration. One in 10 teenagers admits to abusing painkillers, such as Vicodin and Oxycontin. Painkillers cause more overdoses than cocaine and heroin combined. "Access to prescription painkillers has never been easier," says addictions psychiatrist Donna Yi, MD, associate chief of staff and clinical director for The Menninger Clinic and assistant professor in the Menninger Department of Psychiatry & Behavioral Sciences at Baylor College of Medicine. "Many people start taking prescription painkillers for a legitimate reason, for pain after surgery or childbirth, or to deal with chronic pain. As the sense of euphoria and relaxation provided by the drugs gets reinforced, they become increasingly reliant on the drugs even when they no longer need them for pain." Once hooked, patients may doctor shop to get multiple prescriptions to painkillers, forge prescriptions, order painkillers from web sites that don't require prescriptions or take a road trip to Mexico to supply their habits. Teenagers can get prescription painkillers from their parents' medicine cabinets and their friends—even dealers. Because prescription painkillers are so readily available, they don't have the stigma of illegal drugs, like heroin. Yi adds that it may seem much easier and acceptable to swallow a pill than to find a vein, inject yourself with a drug and risk getting AIDS or overdosing. The word "heroin" instantly evokes a negative image—usually that of someone homeless and on the street. However, like heroin, prescription painkillers such as Oxycontin and Vicodin stimulate opiate receptors in the brain, relieving pain and providing a sense of euphoria, and are highly addictive and difficult to quit without medical intervention. Because opiates are so rewarding and reinforcing, once a person stops using them, the body goes into shock and withdrawal. Symptoms of withdrawal are similar to a severe case of the flu and may include fever, vomiting, diarrhea, muscle and bone pain, insomnia, cold flashes with goose bumps and involuntary leg movements. To avoid pain, many people abusing painkillers keep using. New medications help painkiller abusers avoid the painful symptoms of withdrawal and cut the time of withdrawal. The drug buprenorphine was approved by the FDA in 2002 to help ease the symptoms of detoxification and radically decreases the time of detox from an average of two weeks to one or two days. Buprenorphine is a safer alternative to methadone and is available in a convenient pill form. The medication speeds a patient's entry into treatment, cutting down the time he or she is in bed and feeling uncomfortable withdrawal symptoms and drug cravings. Staff at The Menninger Clinic, trained by addictions psychiatrist Dr. Thomas Kosten, began administering buprenorphine to patients undergoing detox in 2007. Kosten, Jay H. Waggoner Professor of Psychiatry & Behavioral Sciences at the Menninger Department of Psychiatry at BCM and research director of the Veteran Affairs National Substance Use Disorders Quality Enhancement Research Initiative, played an instrumental role in discovering the proper dose of the drug to treat humans with opiate dependence. Patients may have accompanying mental illness and issues driving their addiction, such as anxiety, depression, life stresses, relationship problems, personality disorders or poor coping skills. A successful treatment program for addiction includes a thorough patient assessment and offers group and individual therapy, psychoeducation and access to self-help groups. Patients' families are also involved in the treatment process. Relapse rates for patients who abuse painkillers are high, so creating a relapse prevention plan is crucial. Patients at Menninger leave with a wellness plan that might include appointments with therapists, support group meetings and exercise to improve their mood and health. Patients also learn the signs and symptoms that constitute a lapse, so they can stop a full-blown relapse. Some patients may also need medications on a continual basis, such as prenorphine or naltrexone, to help them avoid relapse. Both buprenorphine and naltrexone block the effects of opiates on the body. Patients who take buprenorphine, however, will feel mild withdrawal symptoms if they stop taking the drug—reminding them to consistently take their medicine. Doctors often prescribe a version of buprenorphine, combined with another opiate-blocker, naloxone, to guard against the intravenous use of buprenorphine. If the drug combination is injected, the naloxone can cause that person to quickly go into withdrawal. "As the supply and variety of painkillers increase, more people will try them for non-medical reasons, and some will become addicted," Yi says. "Increased awareness, new medications used to treat painkiller abuse and novel therapies offer hope for people struggling with painkiller abuse." (Editor's note: For more news on addiction, visit Baylor College of Medicine's addiction Web package. The Menninger Clinic is an international specialty psychiatric center, providing treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to Hoarding behavior poses health risks, needs professional help But the problems of people who compulsively hoard clutter go beyond a disorganized home and can’t be solved neatly in a half-hour home organization show or magazine article. Hoarders have a brain disorder resulting in an all-consuming compulsion to collect that often cuts them off from society and damages their relationships. In severe cases, clutter can get so out of control it can endanger lives—as in the case of a “Hoarding is different from being disorganized or not prioritizing,” says John Hart, LCPC, a behavior therapist with the Menninger Obsessive-Compulsive Disorders Treatment Program who treats patients who hoard. “If there is a pathological accumulation of stuff in their home, then something has gone pretty desperately wrong.” A sub-type of obsessive-compulsive disorder, hoarding is the compulsion to collect and store items considered by most people to be worthless or useless. Little is known about what causes hoarding, but like many mental disorders, it is believed in part to have a genetic cause. In some cases, a loss or other significant life event can trigger hoarding behavior. Hoarding behavior may also be present in persons with dementia. The motivation driving the compulsion to hoard varies among persons with the behavior. Some persons who hoard receive pleasure out of collecting items they want, for example a person who loves to shop sales. Even when their purchases begin to overtake their house, they may not think they have a problem. “Friends and family may see the hoarding as a bigger problem than the person who hoards,” Hart says. “They come to visit and there is no place to sit down because of all the clutter.” Other persons who hoard may feel they have no control over their behavior, for example, they feel they must hold on to every piece of mail with their names on it, in case they need it some day, or out of fear of someone using that information against them. Some persons, out of love for animals, may keep too many pets in their home—another form of hoarding. Persons who hoard often have extreme problems with making decisions. Instead of facing the decision to throw something away, they just avoid it. “They have a hard time seeing the big picture,” Hart says. “They don’t see how a little decision, like keeping an old magazine because they haven’t yet read it, can turn into a whole big mess. They have a hard time moving from the particular to the general.” Well-meaning family and friends may try to help by clearing all the clutter away from the hoarder’s home—a temporary solution at best. Without mental health counseling, hoarders usually will go back to hoarding again. For severe cases of hoarding, inpatient treatment may help by removing the person from their hoarding environment and evaluating whether they may also have a co-occurring psychological problem, such as depression or anxiety, Hart says. Patients in the Menninger OCD Treatment program who hoard participate in cognitive behavioral therapy and learn decision making skills. They also work on their beliefs about hoarding, and learn to understand their emotional reaction when they throw items away. For treatment to be successful, it must also happen where the patients hoard. “It is important that they receive some sort |
Menninger will be located within a 10-minute drive from the Texas Medical Center on South Main Street,