Brain Health

Posttraumatic Stress Disorder: How It Affects Veterans and Treatment Options That Can Lead to a Better Life Live Chat

ptsd-chat-calloutThough commonly associated with combat experiences, posttraumatic stress disorder (PTSD) can affect anyone who has experienced a traumatic event, be it a near-death experience, sexual violence, or even a car accident. Some common symptoms include upsetting memories, jumpiness, or trouble sleeping. If these symptoms persist, they can cause severe disruptions to daily life. Emory’s Veterans Program offers effective treatment to post-9/11 veterans who may be suffering from PTSD.

Join Dr. Barbara Rothbaum, director of Emory’s Veterans Program and a leading specialist in the treatment of PTSD,  on Tuesday, September 22 from noon to 1 p.m. to discuss PTSD and approaches to treatment. She will be available to answer in-depth questions regarding types of therapy and treatment  methods offered through Emory’s Veterans Program.

Register for the live chat on September 22 at 12pm here.

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About Dr. Rothbaum

Rothbaum_BarbaraBarbara Olasov Rothbaum, PhD, is a professor in the Department of Psychiatry and Behavioral Sciences and director of the Trauma and Anxiety Recovery Program at Emory University School of Medicine.

Rothbaum is a clinical psychologist who specializes in research on the treatment of individuals with anxiety disorders, focusing in particular on Posttraumatic Stress Disorder (PTSD). She is a pioneer in the application of virtual reality exposure therapy to the treatment of psychological disorders.

Rothbaum has served as a Blue Ribbon Panel Member for Pentagon officials since 2009 and serves on the committee for the Institute of Medicine’s (IOM) Study on Assessment of Ongoing Efforts in the Treatment of Post-Traumatic Stress Disorder (PTSD).

Author of over 200 scientific papers and chapters, Rothbaum has published four books on the treatment of PTSD and edited two others on anxiety.  Rothbaum received the Diplomate in Behavioral Psychology from the American Board of Professional Psychology. She has served on the Board of Directors and as past president of the International Society of Traumatic Stress Studies (ISTSS) and served as Associate Editor of The Journal of Traumatic Stress. Dr. Rothbaum is currently on the Scientific Advisory Boards for the Anxiety Disorders Association of America (ADAA), the Obsessive Compulsive Foundation (OCF), the National Center for PTSD (NCPTSD), and McLean Hospital of Harvard University, and on the Board of Directors for ADAA.

Geriatric Psychiatry: An Interview with Dr. Young

youngMental Illness is real and it does not discriminate—anyone can experience it. Emory Healthcare has a Geriatric Psychiatry department which serves adults age 60 years and older; offering multiple services.

We begin this education series with a spotlight on Dr. Raymond Young, Medical Director for the Emory Wesley Woods Senior Partial Hospitalization Program (PHP) and Intensive Outpatient Counseling Program (IOCP). For more information, please see our previous blogs or our website.

I am a licensed professional counselor in the state of Georgia and am deeply passionate about Emory Healthcare and in specific, the outpatient services in geriatric psychiatry. As a professional in the field and an adult child of aging parents, I was interested to speak to Dr. Young about his views about the geriatric field, our programs in outpatient services, and his overall background. The therapist in me is always interested in how others feel and think, and the adult child in me is always interested in learning more about how to appropriately care for and communicate with the aging population. Dr. Young has multiple roles within the outpatient psychiatry services in Geriatric Psychiatry and was kind enough to allow me to interview him for this blog.

Jenny Barwick, LPC: Why do you think the geriatric outpatient psychiatry programs are important to the community?
Dr. Young: I think they serve a need for a growing population—dealing with aging, loss and our programs provide a resource to cope to have a good quality of life.

Jenny Barwick, LPC: What are your responsibilities and greatest challenges from being our medical director?
Dr. Young: To help provide clinical oversight to patients, provide resources in decision making in their care and therapeutic plans, what level of care is appropriate for them, supervision for clinicians. I think my greatest challenge is having the time to provide support for the programs and time and support to everything else I do.

Jenny Barwick, LPC: What are your criteria for referring patients to PHP and IOCP?
Dr.Young: For me, it is when I see the patient has need or is in distress in managing depression, anxiety, or another clinical issue. Someone who needs frequent attention to develop skills they need to live a productive life and to hopefully prevent inpatient hospitalization.

Jenny Barwick, LPC: Can you describe how geriatric psychiatry is different from adult psychiatry?
Dr. Young: Sure. As a whole, what differs is a set of variables. Number one, life stage. Patients are dealing with retirement, young adult children becoming more independent, losing spouses, friends, facing the need to deal with changing purpose and meaning in life. The patients also deal with more co-morbid illnesses and have a larger impact on their psychiatric health and it impacts how we treat these patients. There are a lot of complexities in geriatric psychiatry that are not present in the adult population.

Jenny Barwick, LPC: Do you believe that patients who have a diagnosis of cognitive impairment or any degree of dementia are inappropriate for group or individual therapy?
Dr. Young: No. I don’t think we can make a blanket statement because a lot of people can still learn and have insight. Our programs are quite helpful and can even be preventive in some ways—because they can learn, have fun, stay active and deal with dementia along with whatever their psychiatric issues are. But, at the same time, not all patients with a dementia diagnosis are appropriate.

Jenny Barwick, LPC: How do your certifications help to serve our patients? (Dr.Young is triple board certified)
Dr. Young: I am board certified in internal medicine, psychiatry, and psychosomatic medicine. My education and background helps me because most patients I see have co-morbidities. This allows me to integrate my knowledge and allows me to have a greater appreciation for psychosomatic.

Jenny Barwick, LPC: Can you talk more about psychosomatic medicine?
Dr. Young:Sure. Psychosomatic medicine is a subspecialty in psychiatry. It was deemed a subspecialty in 2003 and its fast growing. It is looking at psychiatric illnesses and how it impacts medical illnesses and how the medical side can impact psychiatry and then how you integrate these into treatment. This is being used more and more often, especially in primary care and oncology.

Jenny Barwick, LPC: What led you into geriatric psychiatry?
Dr. Young: What led me into it? Some of it is opportunity. Part of my training I did in Chicago was combined with geriatrics. I came to Emory because I wanted to utilize my training and this gives me that opportunity. I have grown to love this population. I am not a board certified geriatric psychiatrist, but I see myself as one.

Jenny Barwick, LPC: How do you stay motivated?
Dr. Young: The patients. The patients keep me motivated. I became a doctor because I wanted to help others and I believe I could do this most in the mental health field. It is always motivating to help.

Jenny Barwick, LPC: What does your typical day look like?
Dr. Young:It varies from day to day because of my multiple roles. I provide oversight for the partial program (PHP). Primarily, my days are spent as being a clinician. I work in the transplant center, outpatient geriatric psychiatry, I work with medically complicated young adults, and I do consultations up at Emory. I also have various administrative educational roles. I am the director of psychosomatic medicine fellowship; I work with the internal medicine psychiatry resident program. I am also involved with the geriatric psychiatry fellowship.

Jenny Barwick, LPC: What do you value the most from working with the geriatric population?
Dr. Young: I feel I can genuinely help. When we help someone who is depressed, anxious, it not only impacts the patient, but their spouse, family, children and it feels good to help the patient and the family. It feels good to make a difference.

Jenny Barwick, LPC: What advice do you have for families or patients who are looking for a psychiatrist?
Dr. Young: It is good to be open to seeing a psychiatrist. Often the biggest challenge is just seeking help. Families have to be open. Often what restricts patients from seeking help is the family not believing they need help. You want to see someone who cares, who gives you the time, and who will communicate effectively with you.

Jenny Barwick, LPC: Where do you see our programs in the next 5 to 10 years?
Dr. Young: Well, I hope I see them continue to grow and expand. I have seen it grown significantly since 2006 and I have seen how it has expanded by amount of patients, clinicians, nursing staff. I hope it gets bigger because people are aging, living longer, and getting older—not younger. There is a need for these programs.

Jenny Barwick, LPC: Where do you see yourself in the next 5 to 10 years?
Dr. Young:I don’t know. Hopefully still at Emory. Still doing my best to take care of my patients. I hope to be more involved in the systems of healthcare—looking at patients overall healthcare and not just the individual.

Jenny Barwick, LPC: How do you think the geriatric psychiatry field can improve serving patients overall?
Dr. Young: I think the biggest hurdle I have seen is just being accessible. There are a lot of people who need our support and are challenged to access our help and support. We need more people in the field to care for the patients. We need to find ways to be more efficient and more accessible.

Dr. Young truly believes in mental health and has a real, genuine passion for what he does. If I could get my own parents to seek psychiatric help, I would want them to come to Emory Healthcare’s Geriatric Psychiatry department because the department has seasoned, passionate doctors such as Dr.Young. Emory Healthcare provides our geriatric patients with individualized treatment and will be treated by doctors like Dr.Young, who see the whole person and not just a diagnosis code. Not only does Dr.Young believe in the care he gives patients, he also believes in the programs Emory offers in outpatient psychiatry. I admire his ability to be vulnerable and demonstrate just how important it is to see the whole patient, and not just a diagnosis. We are all in this together.

For an appointment in outpatient geriatric psychiatry, call 404.728.6302. 

To find out more about PHP and/or IOCP, please call 404.728.6975 or 404-728-4776 . Or visit our facility—1821 Clifton Rd, located first floor next to the cafeteria.

Myasthenia Gravis Awareness Month: 4 Things to Know

lazy-eyeJune is Myasthenia Gravis (MG) Awareness Month. So we asked Emory neurologists Taylor Harrison, MD, and Vita Kesner, MD, to share some information about MG.

What is Myasthenia Gravis?

Myasthenia gravis (pronounced My-as-theen-ee-a Grav-us) is a serious neurological disease caused when a person’s immune system is too active and makes antibodies that cause muscle weakness. Antibodies are proteins made by white blood cells and their primary role is to help the immune system recognize and fight bacteria and viruses. In myasthenia gravis, the antibodies affect the ability of nerve signals to trigger the muscles to contract, resulting in muscle weakness. Approximately 15% of patients with myasthenia gravis have weakness that is limited to the face and eye muscles, and 85% have more generalized weakness which can affect speech, swallowing, arm and leg muscles, as well as breathing muscles. The weakness often fluctuates, tending to be better after rest and worse with sustained physical activity. In some people, the weakness remains very mild but it can be disabling or even fatal by causing weakness of breathing muscles.

How is this condition diagnosed and by whom?

A neurologist plays a critical role in both the diagnosis and management of patients with myasthenia gravis. Many people may display symptoms for some time before a final diagnosis is made.

A diagnosis of myasthenia gravis can be confirmed by the presence of antibodies in the blood. There are different types of antibodies that the doctor may look for. The doctor may also evaluate the function of the thyroid gland, because problems with the thyroid can sometimes look like myasthenia and if a patient has myasthenia, than thyroid problems can make the myasthenia worse. Other important tests include electrical testing of the nerves and muscles. A highly specialized test called single fiber electromyography is another test that evaluates whether nerve signals are making muscle cells fire together, and is typically done when there is uncertainty if weakness is indeed related to a diagnosis of myasthenia gravis.

Is the thymus gland connected to an MG diagnosis?

If myasthenia gravis is confirmed, you doctor may order a CT scan of your chest to look at your thymus gland in your chest. The thymus gland is an important organ in the development of the immune system at a very young age, but stops working as you get older and enter the teenage years. A small percentage of patients with myasthenia may actually have a tumor to the thymus gland, which requires surgery. In some patients with myasthenia who have no tumor surgery to take out the thymus gland may be considered, with the idea that the thymus gland is overactive and removal may improve the myasthenia symptoms. The doctor may also order testing of your breathing to make sure the breathing muscles are strong.

What medications are used for treatment?

There are a number of medications used to treat myasthenia gravis, and it is important to recognize that myasthenia gravis is treatable. Medications such as pyridostigmine (Mestinon®) is used to help with weakness, it helps the nerve signals get to muscles better. Corticosteroids (e.g., prednisone) and immunosuppressant agents (e.g., Imuran®) may be used to suppress the abnormal action of the immune system that occurs in myasthenia gravis. Intravenous immunoglobulins (IVIg) and plasmapheresis, or plasma exchange, may be especially useful during severe myasthenia gravis weakness. IVIG affects the function or production of the abnormal antibodies and plasmapheresis is a procedure that removes the abnormal antibodies from the plasma of the blood. The best choice of treatment for each patient is determined by a neurologist according to the severity of the myasthenia gravis and other existing medical conditions.

If you suspect you have MG or have been diagnosed and would like a second opinion, you can make an appointment with Emory Neurology by calling 404-778-7777.