Psychiatry Rounds: The Children, Gaming, Candles in the Wind

The American Psychiatric Association “called for an immediate halt to the policy of separating children from their parents, emphasizing that forced separation is highly stressful for children and can cause lifelong trauma and related mental illnesses.” The American Academy of Pediatrics echoed that position: “[We strongly oppose] the Border Security and Immigration Reform Act, which was released by the U.S. House of Representatives leadership today. Instead of putting children first by ending the harmful policy of family separation at the border once and for all, this legislation strips children of protections designed for their safety and well-being and exposes more children, not fewer, to detention, including long-term detention. Pediatricians have repeatedly spoken out against the detention of immigrant children; this legislation is not the answer and puts children at greater risk of harm.”

APA Statement Opposing Separation of Children from Parents at the Border • American Psychiatric Association • May 30, 2018

AAP Statement Opposing the Border Security and Immigration Reform Act • American Academy of Pediatrics • June 15, 2018

Gaming disorder is now considered a mental health condition, according to WHO’s ICD-11, released on June 18, 2018.: “Gaming disorder is characterized by a pattern of persistent or recurrent gaming behaviour (‘digital gaming’ or ‘video-gaming’), which may be online (i.e., over the internet) or offline, manifested by: 1) impaired control over gaming (e.g., onset, frequency, intensity, duration, termination, context); 2) increasing priority given to gaming to the extent that gaming takes precedence over other life interests and daily activities; and 3) continuation or escalation of gaming despite the occurrence of negative consequences. The behaviour pattern is of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning. The pattern of gaming behaviour may be continuous or episodic and recurrent. The gaming behaviour and other features are normally evident over a period of at least 12 months in order for a diagnosis to be assigned, although the required duration may be shortened if all diagnostic requirements are met and symptoms are severe.”

6C51 Gaming Disorder • World Health Organization • June 2018

In a cross-sectional survey study of over 26,000 adults found that “prescription medications that have depression as a potential adverse effect was common. Use of multiple medications was associated with greater likelihood of concurrent depression.”

Prevalence of Prescription Medications With Depression as a Potential Adverse Effect Among Adults in the United States • JAMA • June 12, 2018

Massachusetts General Hospital neurologist Alice Flaherty’s work “involves plenty of gadgetry-she heads up the deep brain stimulation unit, and sometimes uses electroconvulsive therapy to help patients with depression or mania-but these days, that’s not the kind of tinkering that’s at the front of her mind…Instead, she has been toying with the boundaries of illness itself. ‘These poor patients are typically seen as just not wanting to get better, and I got interested in that whole thing, like if you want to get better then you’re sick, if you don’t want to get better, then it’s a vice . . . What was it about us-the caregivers, family members, and doctors-what was it that made us attribute willfulness to people who were obviously miserable?’”

It’s not ‘all in your head’: When other doctors give up on patients, a boundary-breaking neurologist treats them • Stat News • June 19, 2018

“Leaders must watch for warning signs their stressed-out colleagues might exhibit, while providing more awareness through education and a greater emphasis on self-care.” For related content, see Psychiatrists and Suicides, by H. Steven Moffic, MD.

Preventing Physician Suicide: Recognizing Symptoms, Improving Support • American Association for Physician Leadership • June 15, 2018.

“The deaths of the designer Kate Spade and the chef Anthony Bourdain, both of whom committed suicide this week, were not simply pop culture tragedies. They were the latest markers of an intractable public health crisis that has been unfolding in slow motion for a generation…Treatment for chronic depression and anxiety - often the precursors to suicide - has never been more available and more widespread. Yet the Centers for Disease Control and Prevention this week reported a steady, stubborn rise in the national suicide rate, up 25 percent since 1999.”

How Suicide Quietly Morphed Into a Public Health Crisis • The New York Times • June 8, 2017

From our June issue: Many people with psychiatric disorders engage in creative activities, from informal hobbies to highly accomplished careers. While some distinguish their symptoms from their creative talents, others avoid treatment, fearing it will impair mental and emotional processes they value. After a brief summary of the complex relationship between creativity and psychiatric illness, this article focuses on the treatment of such patients. Two cases-the mathematician John Nash and the author David Foster Wallace-are presented to illustrate a nuanced approach that integrates medical knowledge with patients’ perspectives.

Creativity and Psychiatric Illness: Finding the Sweet Spot • Psychiatric Times • June 15, 2018