How to help a friend with depression

When you notice that a friend or family member has not been herself or himself for a few weeks, this may be an indication that they may have some form of depression.
While only a professional can give a certain diagnosis, your close relationship with that person makes you very sensitive to their moods, and there is a good chance they need some form of help.

Although this person may not respond positively to your attempt to help initially, there are a number of things you can do to start the healing process. In summary, you need to talk with the person in a certain way, and also educate yourself about the different types of depression. The more you know, the more you can help your friend or family member.

The article below provides a well-balanced strategy to begin to help: 9 ways to help a friend or family member with depression

For professionals to consider a diagnosis of a serious depressive disorder, symptoms need to be present every day for at least two weeks. There are two main categories of depression: Dysthymia, and Major depression. Both are serious conditions, but treatment varies depending on which disorder a person has. WebMD provides clear definitions of Dysthymia and Major depression as well as ‘Depression TV’‘.

How to know if your child has ADHD

This is a question I often hear in my practice. With the steadily increasing awareness of the disorder, there has been a tendency for self-diagnosis in adults, and for parents or teachers to incorrectly label children without proper consultation from a professional trained to diagnose ADHD, such as a pediatrician, psychologist, or psychiatrist.

After pointing you to some excellent links that define ADHD, its treatment options and common misconceptions, I will share with you a summary of my personal experiences  working with ADHD.

Let’s start with a clear definition of ADHD. This article provides information on signs and symptoms, risk factors and treatment options. You will notice the article describes a variety of parenting skills and techniques for working with children, and shows how adults with ADHD can seek help. If you are a parent, or educator concerned about a child, or an adult wondering about the effects of HDHD, please read this article on myths, misconceptions and stereotypes about ADHD

From my experience working with children and adults, I learned that appropriate interventions result in great benefits. One way to think of how these interventions work is by first imagining a straight line. This is the direct path towards normal development which does not require any interventions, whereas the path that uses treatment, specific strategies or therapy to reach the same destination, is curved, or indirect. As with all areas of health, early diagnosis and treatment will result in the best outcomes. 

The balance of reward and punishment

You need a license in order to fly an airplane or to drive a car, but there is no such requirement for parenting. Yet, the result of our actions as parents will strongly influence our children’s behavior and state of mental health.

Today’s tip will focus on shaping behavior by providing appropriate rewards and punishment and adjusting for anything that comes in the middle.

1. Rewards

One of the most common mistakes parents make is not to acknowledge the small steps children take towards exhibiting our desired behavior. Offering simple verbal praise will motivate children to go all the way. An example of this would be when you would like your child to keep his/her room tidy. Even though the room is not quite how you would like it to be, you could say, ‘Thank you for tidying your desk. That makes me happy’.

2. Punishment

A good plan should aim to punish the behavior and not the person. It is also essential to explain why you are upset and to have the child participate in the learning process. One way to do this is to change your face when you are upset and to re-enact the situation with the correct behavior. An example of this would be teaching a child not to throw trash on the floor. With a frown on your face, say why you are upset, then replay the scene and allow the child to throw away the trash correctly. Then you may reward the child.

3. Flexibility

Despite our commitment to provide a consistent reward and punishment environment for our children, sometimes you should allow for times when you neither reward good behavior nor punish inappropriate behavior. These are the times your child will be able to figure it out for themselves.

Global Medicine: Japan

I practice clinical psychology in Japan and received my PhD in developmental psychology. I also hold a civil service certification for the County of LA in the Department of Mental Health, Clinical Psychologist 1, and I am currently a staff clinical psychologist at the University of Tsukuba (Tokyo). 

Japan’s universal health care system pays for 70% of the cost of preventive, curative and rehabilitative services. From my experience living and operating my practice in Tokyo, I have learned that health care is very accessible here.

Preventative care is highly valued, and each year the city sends out free general health check vouchers. In addition, people tend to visit local clinics for minor ailments more than in the U.S. One of the drawbacks is that waiting times in hospitals and clinics can be very long; In the Japanese countryside, there are fewer doctors, and so they are in high demand. 

Scholarships are offered for medical students who promise to do residencies in country hospitals. Because of low reimbursements, however, physicians in Japan see a high volume of patients per day. It means less time with patients, which can change the dynamic of the patient and physician relationship, as well as limit the time patients can ask questions or gain other information about their health and wellness care.

What could be the cause of my dizziness?

Hee-Young Kim, MD, PhD is an Otolaryngologist in Soul, Korea.

Simon R. Downes, What could be the cause of dizziness? 

There are many conditions which may cause vertigo, but obstruction of the Eustachian tube is one of the most obvious, and also the most easily corrected.

The Eustachian tube allows for the equalization of pressure on each side of the eardrum. It is a narrow passage that leads from the pharynx to the cavity of the middle ear. 

How would you diagnose this? 

Eustachian tube obstruction (ETO) is one of the principal causes of ‘hearing loss’ and/or ‘ear fullness’ and/or ‘dizziness (vertigo) and/or ‘tinnitus’ and/or ‘headache (migraine, including otalgia)’. This has been recognized by many well-respected senior doctors for a long time.

Every patient with symptoms of dizziness and/or nausea, and/or vomiting, and/or perspiration should be subjected to the therapeutic test of inflation of the Eustachian tubes as the first step in a thorough clinical investigation.

For the diagnosis and treatment of patients, regardless of whether they are in an emergency room or outpatient clinic, a wide variety of symptoms, and their mutual connections must be considered. For example, it should be considered that dizziness could be originating from Laryngopharyngeal reflux (LPR), GERD or ETO.

Why would you use Eustachian tube catheterization?

‘Eustachian tube catheterization’ may be of both diagnostic and therapeutic value. It is one of the most fundamental techniques for an otolaryngologist. This procedure is more than a century old and was earlier routinely done to check the patency of the Eustachian tube.

My own experience over twenty years of medical treatment has shown
that most cases of dizziness have both Laryngopharyngeal reflux (LPR) and Eustachian tube obstruction (ETO) at the same time.

Where is your clinic?

My private clinic is in Seoul, Republic of Korea.
Web page: www.dr-kiment.co.kr

Thank you, Dr. Kim.

Are opioids used for patients with back pain in Japan?

Taro Minato, MD is an orthopedic surgeon in Yokohama, Japan. His areas of specialty are the upper extremities (shoulder, elbow, hand).

Simon R. Downes: Are opioids prescribed for patients with chronic back pain in Japan?

We seldom prescribe opioids for chronic back pain (or any chronic pain). This is because they have strong side effects and are likely to result in dependency. I would like to say that in general, patients in Japan are more likely to want to endure pain, rather than have medicines prescribed to handle the pain.

Is this also true for foreign patients?

Well, of course, it depends on the patient, but in general, we see that non-Japanese are more likely to request strong drugs to handle back pain – for example, opioids.

What do you commonly prescribe for chronic back pain?

We give NSAIDs. Or, drug plasters, which are sheets that contain medications. We apply these directly to the skin. They mostly contain NSAIDs.

In your practice, do you ever see drug-seeking patients complaining of back pain?

Very few compared to other countries. As I was saying, in Japan, opioids are seldom used. However, I have seen these type of patients before on the night shift who come to get opioids. They ask for a specific drug, saying that only that drug will work for them. I do not give it to them.

Can you tell me the name of an opioid that is prescribed for back pain, and under what circumstances you would prescribe it?

One example of an opioid we may give is Sosegon. The trade name Pentazocine. It may be given for patients with cancer pain. Otherwise, we generally do not give any opioids to patients. Even after back surgeries, we do not give opioids. Rather, we usually only give NSAIDs.

What type of patients come to you with cancer pain?

For example, managing pain for patients with bone metastasis. They have severe pain, and there are few choices for treatment…so we use opioids.

When would you perform surgery on a patient with bone metastasis?

If the surgery can be helpful, for example when a patient has one area of bone metastasis without any organ metastasis. However, it is often the case that patients have multiple areas of metastasis, in which case surgery is not recommended. In these cases, we would give drug treatments (chemotherapy), or perform radiotherapy.

Thank you, Dr. Minato.

New Year’s Resolutions – Is It A Good Thing Or Not?

Healthy New Year’s Resolutions

At the end of last year, or the beginning of this year, many of us made New Year’s resolutions. Whether it was by our own decision, or the result of answering the often asked question by friends or family, “What are your new year’s resolutions?”, we began the new year with a daunting set of challenges. I would like to consider why we do this, whether it a good thing or not, and how we may actually accomplish our goals.

Why do we do this?

While the drive to improve ourselves was most likely started by our parents, it is reasonable to say that as adults, we take responsibility for the creation of our own goals and that we are largely the result of the decisions we have made in our life. Accordingly, if we can accept that we all want the best out of life, it follows that our resolutions or personal promises are representations of our intention to improve how we feel about our lives or ourselves in general.

Is it a good thing or not?

Whether it is a good thing to make yearly goals or not can only be measured subjectively by the result, and of course, the process of living with these goals. While one may say that success can be measured by accomplishing a goal, what is the result of failure? Will the failure to reach our goal have the unexpected result of causing despair, self-disappointment or even depression? Again, this can only be answered by you, the creator of these goals. Perhaps it would be prudent to consider a good strategy for how to approach achieving these New Year’s resolutions.

How may we actually accomplish these goals?

Firstly, I would like to state without reservation, my opinion that a clearly declared personal goal to improve oneself can only be good. Certainly, it is the desire to improve oneself that is the spark that will lead to change, however incremental. What tends to bring people down, however, is when these goals meet initial failure. Often, this results in giving up the goal, disappointment and reverting to our ‘old selves’. The problem here is the premature judgment of defeat and the expectation that behavior can be changed overnight. A much better way to consider the result of a New Year’s resolution is to save your evaluation until the end of the year, regardless of early failure. A long-term goal will be much less likely to result in early failure and disappointment.

What now?

Take a moment to pat yourself on the back (really, do it now) and say, “I’m ok, and doing my best”.  In the end, you will only have yourself to thank for your successes. You have to love yourself, as the love of others, while valuable, should not be the standard by which you measure your own self-worth. And, if you are already feeling bad about the failed promises you made yourself at the beginning of the year, take your resolutions and throw them in the proverbial trash bin. They mean nothing. You are wonderful, just the way you are.