Tina Beychok

Psychiatric stress on caregivers is anarea of mental health care that is oftenoverlooked. In particular, caregiversin high-pressure medical settings,such as ICUs, can suffer from highlevels of stress. As part of a largerreview of psychiatric problems incritically ill medical patients publishedin the January issue of 

, StuartJ. Eisendrath, MD, and J. JewelSchim, MD, of the University ofCalifornia at San Francisco, examinedthe effect of psychological stresson ICU staff.

The unique character of the ICUcan magnify anxiety, depression, andsubstance abuse, all of which are welldocumented among ICU staff. Inaddition, many suffer from burnout,resulting in emotional exhaustion,diminished empathy for patients, anddecreased productivity. ICUs tend tobe chaotic and noisy and to have acontinual stream of medical personnelat all hours, all of which cancontribute to stress levels.

Those who seek ICU jobs are oftenperfectionists who set very highexpectations for themselves. As aresult of such expectations (eg, savingevery patient), even realistic achievementsmay be perceived as failures.Sleep deprivation, long work hours,and changing schedules, particularlyfor residents, may add to the stresslevels of ICU personnel. This stressmay manifest in a number of ways,such as avoiding patients or theirfamilies, conflicts with other caregiversover treatment plans, anger, orpursuing life-saving treatments thatare ultimately futile.

Despite these difficulties, researchershave made progress in identifyingways to reduce ICU staff stress.Support groups, consultation withtrusted colleagues, and identificationof staff emotions can all help in normalizingreactions and improving patient-caregiverrelations. Adjustments tothe physical ICU environment, suchas noise reduction, better scheduling,and consistent leadership can alsohelp improve ICU staff morale.

The researchers concluded, “Havinga forum to express difficulties,stress management programs, andongoing review of policies and procedurescan also be implemented as keyfeatures enhancing prevention andearly identification of burnout.”

Articles

Caregivers in high-pressure medical settings, such as intenstive care units (ICUs), can suffer from high levels of stress, resulting in emotional exhaustion, diminished empathy for patients, and decreased productivity.

News Brief: ICU Staff May Suffer From Psychiatric Difficulties

A survey conducted by the Mental Health Council of Australia (MHCA) found that one in four men thought that the best way to help out a friend with depression was to take them to the local pub for a few beers. Furthermore, the same survey found that 23% of respondents thought that telling a depressed person about their own troubles might help them put things in perspective, and one-third of respondents thought that it would be helpful to tell the depressed person to "put on a brave face." Even more troubling is that 91% of respondents felt that it would be helpful to tell someone with depression to focus on the positive things in life.

According to Grace Groom, chief executive officer of MHCA, this dismissive attitude reinforces the idea that depression is not taken seriously as a health risk. In a press statement, she said, "Asking a depressed person to cheer up or focus on the positive things in life is not helpful. It minimizes and undermines that person's illness by suggesting it is easily overcome and not a serious condition that requires professional treatment."

Knowledge about depression in children and adolescents was also lacking. One in three Australians surveyed thought that severe moodiness and irritability in young people is normal. Approximately the same number thought that depression is a normal part of growing up, and one in five thought that young people with depression or anxiety will eventually outgrow it. In addition, 86% of respondents under the age of 30 said that they would be more likely to turn to friends and family if they suffered from depression rather than seeing a medical professional. Groom suggested that these findings indicate that many children and adolescents with depression are going undetected, as their friends and family may not be aware of the danger signs or may not take them seriously. 

There was some encouraging news, however, in that 91% of respondents felt that it would be helpful to include a depressed friend in social activities--

A recent survey of 1,200 Australians found that many respondents did not understand how best to help people with depression.

Australian Survey Finds Misconceptions About Depression

Data presented at the International Congress of Biological Psychiatry, held in Sydney, Australia, Feb. 9-13, suggested that lamotrigine (Lamictal) may be effective in helping prevent depression in patients with bipolar disorder (BD) who are currently or have recently been manic. Over a period of 18 months, Lakshmi N. Yatham, MBBS, and colleagues at the University of British Columbia in Vancouver studied 175 patients with current or recent mania to study the effectiveness of lamotrigine compared to placebo and to lithium (Eskalith, Lithobid).

The researchers found that, compared with placebo, lamotrigine treatment resulted in fewer interventions for depression (lamotrigine 14%, lithium 22%, placebo 30%) and fewer adverse depressive events (lamotrigine 0%, lithium 4%, placebo 3%). In addition, fewer patients taking lamotrigine had Hamilton Rating Scale for Depression (HAM-D) scores >20 (lamotrigine 3%, lithium 11%, placebo 19%).

Yatham suggested to the press that, based on these findings, lamotrigine should be considered as a treatment during or shortly after an onset of mania, before depressive symptoms re-occur, adding that lamotrigine and lithium could possibly be combined to control both depression and mania--

Research presented at an international meeting in Australia found that lamotrigine may be beneficial against depressive relapse for patients either currently or recently in a manic phase.

Lamotrigine May Prevent Depressive Relapse in Bipolar Disorder

With the recent terrorist attacks on New York City and Washington, D.C., it appears as though the nation is on edge for further occurrences, including the use of biological weapons.

While it is necessary to be vigilant for future attacks, according to Carol North, M.D., professor of psychiatry at Washington University School of Medicine in St. Louis, it is also important to do so without encouraging panic in others. North, who has specialized in studying bioterrorism, stressed in an interview with 

She said, "There will be different responses in different people, ranging from logical to excitable, even for psychiatrists, because we are also human. It is very important to use common sense and be a good role model for patients."

Robert J. Ursano, M.D., professor and chair of the department of psychiatry at Uniformed Services University of the Health Sciences in Bethesda, Md., agreed with North on the necessity for balancing awareness and common sense. Ursano, who has also studied the psychiatric effects of trauma and disaster, told PT, "Psychiatrists need to be able to educate their patients, colleagues and community leaders in the accurate assessment of risk, the normal anxiety and hypervigilance that accompanies serious threat that is of a low probability for any one group, and how to assist families and children in managing feelings of altered safety that may have come since the Sept. 11 event."

One key to helping people deal with anxiety is understanding how the recent anthrax cases in Florida and elsewhere differ from a real bioterrorist attack. North, who stressed that the Florida cases were all contained in a single location and not contagious, said, "Unlike smallpox, the only way to get anthrax poisoning is through contact with the contagion itself. Furthermore, anthrax poisoning is easy to diagnose and treat." She added that she is not aware of any mass hysteria outbreaks in Florida as a result of the cases.

Despite this, Ursano still feels that the threat of bioterrorism is valid. He stated, "Bioterrorism remains of significant concern and, as has been again demonstrated with recent events, [there are a] large number of people who may be worried about exposure when none has occurred. The issues of behavioral and psychiatric responses to bioterrorism are among the most important to be dealt with if our public health system is to be able to function."

Part of helping the public health system contend with the threat of bioterrorism is having reliable research available. North stressed this importance, "Right now, we don't have much good data on bioterrorism. We have to extrapolate and anticipate from what we have available." 

(For more information on the threat of bioterrorism, please see the cover story in the July issue of 

Given the recent anthrax scares, it is important for psychiatrists to be on the alert. However, this should be balanced with the realization that life must continue as normal as possible.

Cautious Wake-Up Call for Bioterrorism

Last month, Gene Usdin, M.D., stepped down as book review editor for 

 editorial board, has been involved with the publication almost since its inception.

 ran its first book review in the December 1989 issue. Starting with the January 1990 issue, Usdin became the editor of "Book Fair" in which six books were reviewed. In January 1993, the section was renamed "Book Reviews." Two years later, the book review section became a regular department.

Senior psychiatrist emeritus in the department of psychiatry at Ochsner Clinic in New Orleans and clinical professor emeritus of psychiatry at Louisiana State University School of Medicine, Usdin has edited 17 books, served on the editorial boards of 14 journals, written numerous articles and book chapters, and was chair of the editorial board for the journal 

. In addition to his editorial contributions, he has received many awards, including the Distinguished Service Award from the American College of Psychiatrists for Outstanding Contributions to and Achievements in American Psychiatry. Usdin served as president of the American College of Psychiatrists as well as several other prominent professional organizations. In 1998, he was awarded an American Psychiatric Association Special Presidential Commendation. The following year, his wife, Cecile, was posthumously awarded a similar commendation, making them the only couple to be so honored by the APA.

Usdin was presented with a Lifetime Achievement Award at the 10th Annual U.S. Psychiatric & Mental Health Congress in Orlando, Fla. When 

 spoke with him shortly afterward (February 1998), Usdin shared his thoughts on the award: "Receiving 

 Lifetime Achievement Award in the latter years of my professional career serves as gratifying recognition of my achievements."

While Usdin's contributions to the book review section will be missed, he will continue to support and guide 