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World of Psychology
Kaiser Permanente’s Sad Mental Health Care in California

Kaiser Permanente's Sad Mental Health Care in CaliforniaCalifornia has some patient-friendly regulations on its books, meant to help patients get the care they need in a reasonable amount of time. One of those regulations is that patients shouldn’t have to wait more than 10 business days for a regular appointment with their health or mental health care provider.

Yet, Kaiser Permanente’s health maintenance organization in the state — rather than abide by the regulation — regularly made patients wanting mental health care wait longer than the 10 business days. In fact, in one case from 2010, the California Department of Managed Health Care (DMHC) fined Kaiser $75,000 for unreasonably delaying a child’s autism diagnosis for almost 11 months! The new report found that anywhere from 17 to 40 percent of patients waited longer than 14 days for an appointment.

Last week, the DMHC was again at Kaiser’s doorstep, finding that Kaiser kept two sets of appointment records to try and circumvent this regulation — a paper appointment calendar and an electronic health record calendar. The DMHC cited Kaiser for “serious” deficiencies in how it manages and provides mental health care services to its patients.

Kaiser Permanente is one of those enormous health care providers that seems to have lost the plot — providing reasonable and timely health care for its customers.

The latest Kaiser investigation by the DMHC was begun based upon a lengthy and detailed report (PDF) published in November 2011 by the National Union of Healthcare Workers — which represents 2,000+ health care employees at Kaiser. In other words, this is Kaiser’s own staff blowing the whistle on the horrible clinical practices they were forced to implement for their patients.

Here’s what the new DMHC report published last week concluded:

  • Kaiser committed “systemic access deficiencies” by failing to provide its members with timely access to mental health services. Instead, large numbers of Kaiser’s patients were required to endure lengthy waits for appointments in violation of California’s “timely access” regulations.

  • Kaiser’s internal record-keeping system contained numerous problems – including a parallel set of “paper” appointment records that differed from the HMO’s electronic records – that hid patients’ lengthy wait times from government inspectors.
  • Kaiser failed to adequately monitor and correct its violations of state law. Records show that Kaiser was aware of its violations, but failed to take action to correct the problems.
  • Kaiser provided “inaccurate educational materials” to its members that had the effect of dissuading them from pursuing medically necessary care and violated state and federal mental health parity laws.

This last point is particularly egregious because Kaiser — in multiple materials across multiple provider sites — suggested there were limits on mental health coverage visits. These limits haven’t been allowed — by law — since the federal mental health parity regulations went into effect in 2010. If you have a mental disorder diagnosis, your coverage is the same as it is for other health conditions. Yet in 2011, Kaiser was apparently still saying things like,

“We offer brief, problem solution focused individual counseling. Research shows many people improve in a single visit. For others, 3 to 6 visits can produce desired changes.”

and

“Health Plan contracts for up to 20 visits per calendar year with various copayments.”

If you read this, it may have dissuaded you from even seeking care, thinking your care would be arbitrarily limited by Kaiser (and not by what’s in your best treatment interests).

Kaiser Wait times

 

Of course, Kaiser claims that since the beginning of 2012, it has worked on fixing these problems. How convenient… yet this isn’t the first time Kaiser has been fined by the DMHC, so let’s just say that I’m a little skeptical of their “fixes.”

“The department feels these findings are really serious. Because of that, we are doing the immediate enforcement referral, which is unusual,” said Shelley Rouillard, chief deputy director of the Department of Managed Health Care.

Kaiser, get your act together. It’s shameful that you treat patients with mental health concerns as second-class citizens in California, and you don’t listen to your own employees. Instead, they have to turn to the regulatory agency in order to have their concerns addressed. In my opinion, that demonstrates a business organization that is clearly broken.

If you’re a patient of Kaiser’s HMO mental health system in California, I feel for you. The report linked above details practices that suggest Kaiser’s mental health patients are getting sub-standard care by overworked, underpaid, and unappreciated clinicians.

 

Read the full story: Kaiser mental health service reprimanded

Read the full DMHC Final Report: Routine Medical Survey of Kaiser Foundation Health Plan, Inc. Behavioral Health Services (PDF)

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Psych Central News
Altered Circadian Rhythm May Help Diagnose Depression

Altered Circadian Rhythm May Help Diagnose DepressionDifferences in a person’s circadian rhythm — such as any changes in light exposure, motor activity and temperature cycles — may help in the diagnosis and treatment of depressive mood disorders, according to new research conducted by the Chronobiology Laboratory in Porto Alegre, Brazil.

The research suggests that these three cycles are disturbed in adults with depression and may play a role in the evaluation of clinical depression and perhaps even differentiate between acute and chronic depression.

Circadian theories have suggested that the circadian rhythm in patients with depression is out of alignment. Stable connections between internal rhythms, such as temperature and rest/activity, and the external day-night cycle are considered vital for adapting to life in the external world.

Maria Paz Hidalgo, M.D., Ph.D., and colleagues conducted the new study to investigate “chronodisruption” in people with depression.  They also looked into whether the rhythm differences could differentiate between healthy individuals and patients with acute and chronic depression.

The study involved 30 women: 10 met criteria for a first depressive episode (never treated), 10 had major recurrent depression (taking antidepressants) and 10 were healthy, age-matched controls. None of the participants were jet-lagged or had performed shift work in the month before the study.

The rhythm variables — light, motor activity, and temperature — were continually assessed during a period of seven days.

The researchers found differences in rest/activity, peripheral temperature, and light intensity rhythms in depressed patients compared with healthy individuals. These variables may help differentiate between acute and chronic stages of depressive disorder.

With regard to the rest/activity rhythm, women having their first depressive episode and those with chronic depression showed a decrease in amplitude (smaller time difference between the peak and crest of the cycle) compared with the control group.

These differences were lower according to the severity of the illness, the researchers said.

“Because this variable was found to be a high coefficient for discriminating chronic depressive patients, it could be an important tool in clinical practice to evaluate the stage and prognosis of major depressive disorder,” said the researchers.

Depressed patients also showed lower amplitude in the circadian rhythm of light exposure, but a higher amplitude in the rhythm of temperature.  Temperature remained above average for a longer time period in the depressive groups compared with the control group.

The researchers also found that the amplitude of the activity rhythm was capable of discriminating healthy individuals from acutely depressed patients.

Source:  BMC Psychiatry

 

Abstract of body system and light by shutterstock.

Psych Central News
Facebook Profile Often Used for Self-Affirmation

Facebook Profile Often Used for Self-AffirmationA Facebook profile may enhance feelings of self-worth because it offers a place to display the personal traits and relationships the user values most, according to new research at Cornell University.  

In fact, after someone gets an ego setback in the real world, he or she may unconsciously gravitate to their online profile to reboot self-esteem, says the report.

The paper explains that people often fulfill their fundamental need to view themselves as valuable and worthy by making themselves aware of what they consider the defining aspects of their sense of self, including values, goals and personal relationships.

“The conventional wisdom is that Facebook use is merely a time sink and leads to an assortment of negative consequences.

“But our research shows that it can be a psychologically meaningful activity that supplies a sense of well-being at a relatively deep level,” said co-author Dr. Jeff Hancock, Cornell professor of communication, and computer and information science.

“The extraordinary amount of time people spend on Facebook may be a reflection of its ability to satisfy ego needs that are fundamental to the human condition.”

The study was co-authored with Catalina Toma, Ph.D., as part of her dissertation. She is now an assistant professor at the University of Wisconsin, Madison.

For the study, 88 undergraduates were asked to give a brief speech. As the participants waited for feedback, they were allowed to look at their own Facebook profile or someone else’s.

After a few minutes, each participant was given negative feedback about his or her speech, no matter how well they actually did.  They were then asked to rate how accurate they felt the feedback was. Participants who viewed their own profile were less defensive about the negative feedback than those who looked at someone else’s profile.

In another test, students were given either negative or positive feedback about their speech. This time, however, they had the option of browsing their own Facebook profile or other online sites, such as YouTube or news sites.

Students who had received negative feedback were more likely to choose Facebook than those who received positive feedback, the research found.

The study suggests that Facebook profiles could be used strategically in applied self-affirmation interventions, said Hancock.

Also, the experience of engaging with one’s profile-based self may give emotional benefits to millions of social network users, he said, by restoring deep-seated notions of themselves as a good person loved by a network of friends and family.

“Perhaps online daters who are anxious about being single or recently divorced may find comfort in the process of composing or reviewing their online profiles, as it allows them to reflect on their core values and identity,” Hancock said.

“Students who are feeling stressed about upcoming exams might similarly find solace in their social networking site profiles.”

“As a widely available, everyday source of self-affirmation, Facebook appears to be a useful instrument in people’s efforts to preserve self-worth and self-integrity,” said Hancock.

Source:  Cornell University

 

Facebook on a computer screen by shutterstock.

Advice Even Freud Would Envy

Posted: March 24, 2013 in Uncategorized
World of Psychology
Advice Even Freud Would Envy

Advice Even Freud Would EnvyTraditional psychoanalysis has the patient coming to treatment three to four times a week, lying on a couch and free-associating to whatever comes to mind.

The theory behind this treatment is that free-association increases awareness of what is in the unconscious mind. Once you make the unconscious conscious, patients should, theoretically, become less neurotic.

That type of treatment seemed to work well for the idle rich in the late 19th and early 20th centuries.

But does it work well in the digital era?

No way. We want our problems solved quickly. We want solutions to be provided speedily. We savor the power of parsimony. The fewer the words, the more we value them. Short, sweet and to the point is preferable.

Is it possible to take the wisdom of Freud and apply it to the Twitter generation? I’m going to give it a shot. Here goes:

  1. Quit comparing yourself to the best. You don’t have to be the best to make a valuable, worthwhile contribution to the world.
  2. Don’t belittle yourself. Quit calling yourself derogatory names. Laugh good-naturedly at your mistakes, but don’t denigrate who you are and what you’re about.
  3. Avoid sitting on the sidelines, bemoaning your circumstances without taking any action to improve your lot in life.
  4. Even the best ideas are worthless unless you use your energy to execute them.
  5. When you’re overstressed and overworked, take a break. Rest. Relax. Enjoy. Be with optimistic people. Then, get back to work.
  6. Tolerate disappointment. There are days in which nothing works out well. This is a “bad day.” Don’t make it into a life position.
  7. Allow your interests to emerge in their own way. Don’t attempt to make them fit into the box you (or others) think they should fit into.
  8. Because a decision didn’t work out as expected doesn’t necessarily make it a bad decision. Reflect on what went wrong, however, before you move on to your next decision.
  9. Acknowledge what you experienced in your early years. But put your energy toward living in the present where making good decisions can truly enhance your life.
  10. Keep doing what you enjoy doing even if there’s no immediate reward to it.
  11. When you believe in yourself, it’s amazing what you can accomplish.
  12. Success is not an overnight happening. It’s the result of a consistent, driving energy that keeps you engaged, focused and moving forward.

Well, there it is. A dozen pieces of advice — short and succinct. Freud would appreciate, maybe even envy them.

Will just reading this advice allow you to make dramatic changes in your life? I doubt it. Freud was right. It takes time to change ingrained ideas and tenacious habits. But does it take as much time as Freud believed? Absolutely not!

Our sense of time is dramatically different than it was for people who lived 100 years ago. A few months of therapy once a week or even bi-monthly can help people truly change the direction of their lives by clarifying their thoughts, modifying their emotions and expanding their options.

And long-term therapy (still only once a week) is an amazing experience that can transform a life — from one that’s plagued with stress, tension and negativity to one that’s enriched, energized and full of enthusiasm.

Psych Central News
Acting Out Dreams Linked to Development of Dementia

Acting Out Dreams Linked to Development of Dementia  The strongest predictor of whether someone is developing dementia with Lewy bodies — the second most common form of dementia in the elderly — is whether they act out dreams while sleeping, a new study has discovered.

Researchers at the Mayo Clinic report that men in particular are five times more likely to have dementia with Lewy bodies if they experience a condition known as rapid eye movement (REM) sleep behavior disorder than if they have one of the risk factors now used to make a diagnosis, such as fluctuating cognition or hallucinations.

REM sleep behavior disorder is caused by loss of the normal muscle paralysis that occurs during REM sleep. It can appear three decades or more before a diagnosis of dementia with Lewy bodies is made in males, according to the researchers.

The link between dementia with Lewy bodies and the sleep disorder is not as strong in women, they note.

“While it is, of course, true that not everyone who has this sleep disorder develops dementia with Lewy bodies, as many as 75 to 80 percent of men with dementia with Lewy bodies in our Mayo database did experience REM sleep behavior disorder. So it is a very powerful marker for the disease,” said lead investigator Melissa Murray, Ph.D., a neuroscientist at Mayo Clinic in Florida.

The findings could improve diagnosis, which can lead to beneficial treatment, Murray added.

“Screening for the sleep disorder in a patient with dementia could help clinicians diagnose either dementia with Lewy bodies or Alzheimer’s disease,” she said.

“It can sometimes be very difficult to tell the difference between these two dementias, especially in the early stages, but we have found that only 2 to 3 percent of patients with Alzheimer’s disease have a history of this sleep disorder.”

Once the diagnosis of dementia with Lewy bodies is made, patients can use drugs that can treat cognitive issues, Murray said. No cure is currently available.

Researchers at Mayo Clinic in Minnesota and Florida examined magnetic resonance imaging (MRI) scans of the brains of 75 patients diagnosed with probable dementia with Lewy bodies. A low-to-high likelihood of dementia was made upon an autopsy examination of the brain.

The researchers also checked the patients’ histories to see if the sleep disorder had been diagnosed while under Mayo care.

Using this data and the brain scans, they matched a definitive diagnosis of the sleep disorder with a definitive diagnosis of dementia with Lewy bodies five times more often than they could match other risk factors, such as loss of brain volume, which is now used to aid in the diagnosis.

The researchers also showed that low-probability dementia with Lewy bodies patients who did not have the sleep disorder had findings characteristic of Alzheimer’s disease.

“When there is greater certainty in the diagnosis, we can treat patients accordingly,” Murray said. “Dementia with Lewy bodies patients who lack Alzheimer’s-like atrophy on an MRI scan are more likely to respond to therapy — certain classes of drugs — than those who have some Alzheimer’s pathology.”

Source: Mayo Clinic

 

World of Psychology
7 Tips on How Not to Let Wedding Fever Ruin Your Relationship

7 Tips on How Not to Let Wedding Fever Ruin Your RelationshipThis guest article from YourTango was written by .

Melissa and Tom (whose names have been changed to protect their privacy) argued as they drove to meet their vocal coach.

“Why do you want to sing The Wind Beneath My Wings?” she asked. “It’s such a cliché, and I’ll never hear the end of it from my Dad.”

“You’re not doing much better with that Shania Twain song,” Tom rebutted, “Everyone’s going to hear it and remember that Shania Twain’s husband left her for the assistant. Doesn’t bode well, does it?”

Melissa and Tom were determined to make their June wedding an entertaining event, complete with readings by Melissa’s sisters, both of whom are actresses, and additional music by Tom’s brother, who is a singer/songwriter. Melissa wanted to wear a green dress to symbolize her commitment to environmental issues, but Tom worried that people would think it was strange.

So many details! Should they select chairs by price or comfort? Should they go with freesia or flowers that are more showy? Which kind of champagne should they choose for the toast? Chocolate fountain or Viennese table? And then there are the seating charts.

Tom and Melissa spend their non-working hours fighting about, well, everything wedding-related. Tom is beginning to question whether he really wants to marry Melissa, and Melissa wonders why she never noticed how conventional Tom is. Does he really value his uptight relatives’ opinions about the color of her dress more than he cares about her only opportunity to don her dream dress?

Does their situation sound familiar to you? We’ve all known a Bridezilla or two — women who are so over-the-top about the wedding that they forget about the groom. But what happens to couples that get so lost in wedding planning that they forget to focus on the bigger issue — namely, the marriage that lies ahead?

With that question in mind, here are my “lucky seven” suggestions for getting the focus where it belongs, so that you and your fiancé can get your marriage off to a good start:

1. Relax about the appearances, starting with yourself and your fiance.

This is not the time to drop twenty pounds, become a marathon runner or turn him into a gym rat. My client Emma got engaged to Kurt (both names have been changed), booked a personal trainer for three sessions a week, and began a crash diet. Eight months after the wedding, she came to see me because she wasn’t enjoying her life — just as she hadn’t enjoyed her engagement or her wedding.

Thinking back about her wedding, she said, “I have beautiful wedding pictures, but I wish I’d bagged the trainer and the diet and had fun instead! I was a size zero on my wedding day, and Kurt jokingly referred to me as his incredible shrinking bride. He likes curves, but I was stuck on this idea that if I was the thinnest, blondest bride, I’d be the happiest bride.” She laughs ruefully. “So there I was: the most uptight bride. And poor Kurt! I had him biking thirty miles five days a week to get in shape. Not fun!”

2. The devil is in the details.

Usually that phrase means to pay attention to the details, but if you get stuck in all the wedding details, you’re missing the fun. Is anyone really going to remember whether you had the lavender napkins or the deep purple ones? If they do, that’s their problem! I assure you that beveled edges on the cakestand can’t guarantee a good marriage.

3. Stick to your budget.

Your relationship isn’t going to fail if you get married in a garden or a church instead of a Spanish castle, but regardless of the venue, there are choices all along the way that can either break your budget or respect it. Why start your marriage with the stress of unnecessary debt? The wedding is about your commitment to each other; it’s not proof of your magnificence.

4. Don’t stress over the wedding vows.

Approach your wedding vows as something you want to say to your partner, rather than a proclamation to the world of your love or proof of your brilliance. Steve and Betsy (names changed) spent several weekends camped out at opposite ends of their apartment with writer’s block, trying to compose the perfect wedding vows. Would people think the vows were silly? Were they too emotional? Too unconventional? Too sexist?

I suggested that they talk to each other about what they especially love about each other, something they struggle to accept about each other, and take their vows from that. After all, It’s not for Bartlett’s Quotations; it’s for you and your partner. And since you and your partner are not Tom Hanks winning an Academy Award and using the acceptance speech as a love letter to your partner, take the pressure off and remember that the traditional vows are there for a reason. Alternatively, you can look online for some that fit your style.

5. Think of the reception as a fun party for you to enjoy with your friends and family.

One bride’s father had the idea that the reception should be a cabaret show, and it was his responsibility to keep all the guests entertained. The bride and groom wanted something fun and low-key, not a spectacle that demanded everyone’s attention. They put together a playlist of songs that had meaning for them, ones they knew their older relatives enjoyed, and ones they knew would get people out on the dance floor. They looked at the reception as a fun party, not a place to prove their talent, hipness or anything else.

6. If possible, outsource the planning.

Jane’s mother loves planning parties and was thrilled that Jane and Philip (names changed) gave her the basic idea of what they wanted before turning her loose to be creative. Meanwhile, Eliza and Mark (names changed) couldn’t afford a wedding planner and didn’t have relatives who could pitch in, but they had a group of very talented friends who volunteered to manage the various parts. They gave each friend a budget and free rein.

One friend was a sous chef at a fancy restaurant who volunteered to prepare the food, another one did the flowers, Eliza’s brother sang at the ceremony and had musician friends join him to provide music for the party, and Mark’s sister shot video. If you don’t have a close relative with those talents who’s enthusiastic about taking on the plans, hire a wedding planner.

7. Remember that you and your partner are on the same side!

Your partner may not be as interested in all of the “stuff” as you are, whether it’s registry “stuff” or what type of wedding you have. That doesn’t mean he’s wrong or doesn’t care about you. It just means that he’s not you.

Not everyone has an opinion about everything connected with the wedding. He may be more focused on planning a fun trip and enjoying being together when the whole thing’s done. He may be more interested in marrying you than in being your groom. When you have a difference of opinion or approach, stop and say — aloud, or to yourself — “I think we’ve forgotten we’re on the same team, which is the whole point! Let me do something warm to connect with you.”

These “lucky seven” tips are variations on a theme: It’s the marriage that’s important. If you and your partner can stay on the same side, relax about appearances, compromise and have fun with each other along the way, you’ve learned some of the basics of a satisfying married life!

 

More marriage advice from YourTango:

Psych Central News
Early On, Schizophrenia Marked By Worse Cognitive Problems Than Bipolar

Schizophrenia Marked By Worse Cognitive Problems Early On Than BipolarAlthough patients with bipolar disorder, bipolar psychosis, and schizophrenia share several early risk factors, patients with schizophrenia often have more severe cognitive problems during childhood than those with bipolar disorder, according to a new study.

Bipolar disorder and schizophrenia share several elements including age of onset, family history patterns, as well as similar symptoms leading up to the disorder.  Patients who develop bipolar psychosis have even more in common with those who develop schizophrenia.

However, until now, there has been minimal research into how cognitive impairment in childhood and adolescence differs between individuals who later develop schizophrenia compared with those who go on to develop bipolar disorder or bipolar psychosis.

To further investigate these early risk factors, Larry J. Seidman, Ph.D., of the Department of Psychiatry at Harvard Medical School recently conducted a study using data from 99 patients with either bipolar psychosis or schizophrenia as well as data from 101 nonpsychotic control participants.

Seidman assessed the participants’ IQs and cognitive abilities using data from school tests when they were seven years old and also looked at family history to determine its influence on future psychosis.

He found that although bipolar disorder, bipolar psychosis, and schizophrenia all shared early risk factors, the participants with schizophrenia had more severe cognitive impairments and memory and attention deficits in childhood than the participants with bipolar disorder or bipolar psychosis.

Family history greatly increased the risk for psychosis in all of the participants — most prominently in those who developed schizophrenia. The patients with bipolar had the lowest levels of cognitive impairment and academic problems in childhood, followed closely by those who later developed bipolar psychosis.

Seidman hopes that these study findings will give educators valuable information that can be used to identify children most at risk for future psychotic problems. He also believes that these findings could help prevent children from being misdiagnosed with other conditions that often mimic symptoms arising before the actual illness, such as defiance issues or attention deficit hyperactivity (ADHD).

Children with neuropsychological problems, especially those with a family history of psychosis, should be closely monitored and targeted for early identification of schizophrenia, bipolar disorder or bipolar psychosis, said Seidman.

“Future work should assess genetic and environmental factors that explain this [family history] effect,” he said.

Source:  Psychological Medicine

 

Abstract of schizophrenia by shutterstock.