Friday, March 26, 2010

Vitamin G (B2)

Vitamin G is what they used to call Riboflavin/B2 in the old days (I’m guessing because the discoverer’s name was Gyorgi). More on B vitamins here.

It functions in body growth and red blood cell production and helps in releasing metabolic energy (from fats, ketone bodies, carbohydrates, and proteins).

Indications of riboflavin deficiency include cracked lips; inflammation of the mouth and tongue; mouth sores; sore throat; oily, scaly skin rashes on the scrotum, vulva, or area between the nose and lips; red, itchy eyes that are sensitive to light; and iron-deficiency anemia. The nervous symptoms of riboflavin deficiency include numbness of the hands and decreased sensitivity to touch, temperature, and vibration.

Sources include lean meats, eggs, legumes, nuts, green leafy vegetables, dairy products, and milk provide riboflavin in the diet. Breads and cereals are often fortified with riboflavin.

Because riboflavin is destroyed by exposure to light, foods with riboflavin should not be stored in glass containers that are exposed to light.

The RDA for adults is about 1.1 – 1.3mg.

Toxicity is extremely unlikely, except in cases of injections. Riboflavin is water soluble and any excess is excreted through the urine.

Friday, March 19, 2010


The relation rock climbing = dangerous = possible psychiatric disorder does get mention in the DSM-IV (masochism is one diagnosis). But this is a pretty tenuous relationship even within the DSM.

Climbing, indoor or outdoor, isn’t nearly as dangerous as it is scary, and it’s not terribly frightening either.

But where it is either of those things, there is a wonderful opportunity to develop self-confidence, risk-taking (the good kind – where fear would otherwise hold you back from achieving a goal), trust (in the person belaying you), and to overcome anxieties such as may be associated with heights (after you fall a couple of times you realise it’s perfectly safe. You can then train yourself to take bigger falls).

Besides the above, climbing has many other advantages in aiding with mental health.

• It is a very supportive social outlet. Climbers, sometimes even ones who don’t like each other, tend to support and encourage each other.
• It’s exercise - with all of the associated mental health goodness.
• It can help with problem solving skills as you need to assess the route both before and during climbing in order to choose your next move.
• It brings greater awareness to the body and what it, and you, are capable of. You might need to train to do a specific move or you might just try something and be amazed at the efficiency and pliability of the human body.

There isn’t much climbing specific research in relation to psychiatry, but this article found that climbers, regardless of their skill level, had “internal motivational orientation and positive physical self-perception.”

This is an article with some interesting details in its study design (participants had to pay in order to participate), but it supports my opinion, so I’m going to cite it. The study (which included five days of rock climbing) found an “increase in formal and informal social interactions, motivation to learn, and optimism to learn, and [a] decrease in symptoms…”

Friday, March 12, 2010

Is it ok for a therapist to accept/give gifts?

Is it ok for a therapist to accept gifts?
This is something that varies between therapists, with some drawing an absolute boundary at ‘no, not ever.’ While certain gifts such as those of large monetary value, of cash itself, should be gently and graciously turned away, small trinkets of acknowledgment and gratitude can be accepted. The hurt that could be caused by such a rejection may not justify rigid boundaries. The intent of gift should be examined in any case and if gift giving becomes overly compulsive, acceptance of the gifts would need to stop.

Is it ok for a therapist to give gifts?
Yes. Because presents are shiny and they make people happy. Seriously though, at certain times gift giving may be appropriate and alleviate loneliness. Again, the gift should have little or no monetary value. Something like a card during the holiday season or on a birthday would be acceptable.

Wednesday, March 10, 2010

Managing Your Time During Session

Fifty minutes goes by quickly, and a lot happens in a week, so it can be frustrating when session has ended and you haven’t discussed all of the issues important to you. Of course, there is never going to be enough time to discuss everything, but it is important that what is most relevant to you is covered.

Here are some suggestions that may help you optimise your time with your therapist:

* Keep track of important events and feelings that occur throughout the week. Make some brief notes if you have trouble remembering details later, but do not put any lengthy descriptions on your list. Give yourself some time before session to review your important topics and prioritise which events you most want to discuss.

* Make notes during session. A lot of different thoughts will occur and a lot of conversation will be exchanged. If your memory is poor, which is common during emotional states, you may have trouble later recalling advice you had intended to remember or thoughts that came up but didn’t fit into the conversation at the time.

* Make a list after session of things you would like to discuss the following week. Review and edit this list before your next visit.

* Allow for developments. Don’t be too strict in how you want the session to go. Let conversations, relationship dynamics, and topics develop naturally and work on what comes up.

* Keep an eye on the clock. You may have to postpone one discussion in order to ensure another is given air.

* Recognise avoidance behaviours which waste time and alter ambivalence in order to get more work done.

* Don’t worry if you feel like you’re wasting your time talking about ‘trivial’ topics; a lot of therapy is in the how you address any topic. Use your time in session to practice healthy behaviours and challenge new thinking models.

Monday, March 1, 2010

Rabbit Syndrome

Rabbit syndrome (RS) is a rare extrapyramidal condition in which a person has involuntary, fine, rhythmic movements along the vertical axis of the mouth at a frequency of approximately 5 Hz. The syndrome is associated with long-term use of older antipsychotics and may appear either during treatment or after discontinuation (3). The absence of involvement of the tongue and persistence in Stage 1 non-REM sleep (2) distinguishes RS from tardive dyskinesia (TD).

Similar to TD, however, RS may be triggered or intensified in physically or cognitively stressful situations.

RS also shares some similarities with Parkinson’s disease in that it may be associated with drug-induced parkinsonism and symptoms persist during stage 1 non-REM sleep.

Populations of the middle-aged to elderly, women, schizophrenics, and those with previous brain damage are more at risk for RS (1).

Of the older neuroleptics, haloperidol is most commonly associated with RS followed by
piperazinic phenotiazines (Fluphenazine, Perphenazine, Trifluoperazine). (1)

Of the atypicals, risperidone has the highest incidence of extrapyramidal symptoms.
Others include clozapine, olanzapine and aripiprazole (4). I have also seen a case report of quetiapine induced RS in a bipolar patient (5). Conversely, there was also a case study of RS being treated with quetiapine in a schizophrenic patient (6).

RS can be treated with anticholinergic agents such as benztropine, biperiden, procyclidine and trihexyphenidyl typically disappearing in a few days. However, there is the possibility that RS will reappear after stopping anticholinergic medications. A drawback to this treatment though is that the same agents may lead to the development of TD. (1)

A case report of olanzapine treated RS (7).

References: 1, 2, 3, 4, 5, 6, 7, 8