Mental Health

Takeaways from Dr. Bergquist’s Live Chat on Stress Management

stress-cil-638Thanks to everyone who attended our live chat, “Managing Your Stress,” Tuesday, Dec. 22, with Sharon Horesh Bergquist, MD, who serves as Emory Healthcare Network primary care physician and associate professor with the Emory University School of Medicine.

Dr. Bergquist fielded some great questions on a range of topics, including:

  • Stress and its relationship to autoimmune disorders
  • Stress effects on aging
  • Anxiety attacks
  • Best stress-relieving activities
  • Managing grief during the holidays
  • Good stress and how to make stress work for you
  • The effects of stress on migraines
  • How your primary care physician can help you manage stress

If you didn’t get a chance to join us, read the full transcript from “Managing Your Stress” here.

Two questions didn’t get answered during the live chat, so we’re sharing them here, along with Dr. Bergquist’s responses:

Question: Are other SSRIs as effective as fluoxetine for treating SAD?

Answer: SAD can stand for social anxiety disorder as well as seasonal affective disorder, so I wasn’t sure which one is being asked here.

For social anxiety disorder, the SSRI paroxetine and the SNRI venlafaxine are effective. Older drugs from a family called MAO inhibitors, such as phenelzine can also be used.

Seasonal affective disorder, a seasonal pattern of recurrent depression in fall or winter months, can affect 1.5% to 9% of people. It is typically treated with antidepressants, light therapy or psychotherapy.

There are actually very few high quality studies looking at the best anti-depressant for seasonal affective disorder, and there is virtually no data comparing SSRIs for treating SAD. The data is limited to studies on fluoxetine compared to placebo (in which fluoxetine shows a non-significant benefit) and fluoxetine compared to light therapy (it is nearly equivalent). Other SSRIs are commonly used in practice for SAD but there is little data to know if they are effective.

A recent review on the topic found bupropion XL to be an effective alternative for preventing recurrences of SAD (but even here it was effective at best in a small percent of people, around 20%).

Question: Due to psychoneuroimmunology, if a person has cancer, does distress increase the risk of cancer recurrence?

Answer: A relationship between stress and cancer progression has long been suspected. Recently, through animal cancer models, we are learning that the molecular link between the two may be through the beta-adrenergic signaling pathway which mediates the sympathetic nervous system induced fight-or-flight response.

Stress, through the beta-adrenergic pathway, may contribute to the progression and metastasis of a cancer . (Immune mediated macrophages can infiltrate some tumors such as breast cancer and, like a switch, induce pro-metastatic genes to be expressed.)

The stress hormones epinephrine and norepinephrine can attach and turn on receptors on tumor cells to control a variety of function involved in progression, such as proliferation, migration and invasion. Yet, little research is available to answer the question about whether distress can increase cancer recurrence.

Dr. Bergquist is an Emory Clinic Primary Care Physician and Assistant Professor of Medicine at Emory University School of Medicine. Her expertise includes healthy aging, heart disease prevention and management, women’s health, diabetes, nutrition and obesity counseling and treatment of mood disorders, such as anxiety and depression. She has appeared in over a hundred health segments, including Good Morning America, Fox New Network, CNN and Fox 5, has served as an editorial consultant for WebMD and wrote the TED Ed Lesson, “How Stress Affects Your Body.”

Below we have also highlighted some questions that were asked during our live chat.

Question: It’s been said that a certain amount of stress is good. How does a person maintain a good level of stress without tipping over into chronic debilitating stress?”

Short-term stress is advantageous—not only can it help us perform our best but even supports resilience at a cellular level. Stress becomes debilitating or “toxic” when it is prolonged or recurrent, such as worrying about a sick child or finances. The interaction between stress hormones and the hormones and immune cells, among others, throughout our bodies are responsible for both the good and adverse effects.

Question: How does stress affect aging?

Stress has been associated with decreasing longevity and shortened telomeres. These are the shoelace tips at the ends of chromosomes that allow DNA to get copied every time a cell divides without damaging the cell’s genetic code. With each cell division , telomeres shorten until a cell eventually dies. Stress accelerates this process.

In one study done on mothers who were either caregivers of healthy children or children who were chronically ill, the women who felt the most perceived stress had telomeres that were shorter on average by the equivalent of a decade of aging compared to mothers that felt the least stressed.
How much does exercise really help with stress?

Exercise is one of the most effective ways to manage stress. Exercise can reduce cortisol, which is otherwise known as the “stress hormone”. Exercise can also improve other neuroendocrine changes that take place from chronic stress, and it can reduce the immune system mediated damaging inflammation that occurs from chronic stress.

Question: Mindfulness- what does this mean and what role does in play in stress management?

Mindfulness is actively focusing on the present, and observing your moment to moment thoughts and emotions without passing judgment on them. It’s the opposite of being mindless. Mindfulness has become a widely used way of reducing stress, helping with concentration and focus, increasing compassion and self-awareness, and controlling emotions.

Question: Can a certain diet affect your stress levels?

Omega 3 fatty acids are vital for proper nerve function. A diet that is high in omega-6 to omega-3 fatty acids can exacerbate the chronic inflammation that can be triggered by chronic stress and can adversely affect brain function. . Refined carbohydrates, such as sugar, can cause a spike and then a drop in your blood sugar level. People can feel irritable when their blood sugar drops. B vitamins, zinc, and magnesium are necessary in sufficient amount to support our brain chemicals. There is also a lot of research linking gut bacterial balance and brain health. Fiber rich foods support a healthy gut while sugar, fat, and processed food can disrupt gut bacterial balance.

To view the entire chat transcript click here.

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.

Partial Hospitalization Program – What is It?”

Partial Hospitalization ProgramI have been a part of the Emory family for 6 years. Over the past 6 years, I have worked in the Transitions Seniors Program, better known as PHP. When attending different community events, a question I hear all too often is, “PHP? What’s that?” PHP is short for Partial Hospitalization Program. I hope this blog can answer the question, “PHP? What’s that?”

What is Partial Hospitalization Program?

Partial hospitalization is defined by the American Association of Partial Hospitalizations as: A distinct and organized intensive psychiatric outpatient treatment that closely resembles short-term inpatient program. The Medicare psychiatric partial hospitalization benefits were established to provide patients with an acute mental illness, services in lieu of inpatient psychiatric care (Block & Lefkovitz, 2009). The PHP patient care is an individualized treatment plan developed by the physician and a multidisciplinary team with input from the patient.

Who is part of the multidisciplinary PHP team?

Our team includes a physician, a program director, four licensed therapists, a registered nurse, and an advanced practice nurse. All team members are very experienced in the mental health field and serve our patients with pride, compassion, and integrity.

Who should use PHP?

Patients admitted to a PHP program require a minimum of 20 hours per week of therapeutic services. Here at Emory Wesley Woods, we have a PHP program that is geared specifically towards older adults. We target patients who are 60+ struggling with a mood disorder (such as depression, anxiety, bipolar, etc.) and need a higher level of care than outpatient treatment. Patients do not need a doctor referral; however, they must meet certain diagnostic criteria.

About Our Program

Emory Healthcare’s Transitions Senior Program (PHP) of Wesley Woods was established in 1997. It is a hospital based program represented by the National Association of Psychiatric Health Systems and is part of a larger continuum of care for older adults. As of 2013, we were also recognized under the Joint Commission as a “Top Performer on Key Quality Measures.” According to the Joint Commission website, to be recognized, is a “symbol of quality that reflects an organization’s commitment to meeting certain performance standards.” We are honored to have this. Click here for more information on Joint Commission.

The Transitions Senior Program is designed to provide intensive therapy to older adults experiencing behavioral health difficulties. The structured format provides medical monitoring as well as therapeutic groups on a wide range of topics. The program can be used as a step down from inpatient treatment for older adults needing an intensive level of care, but not hospitalization. Additionally, the program can be a preventive measure for patients at risk of inpatient hospitalization. The advantage of this program is that patients are able to continue their normal life activities with very minimal disruption. After assessment of needs, each patient receives a personalized treatment plan. The therapy program is voluntary and is conducted daily from 10:00 am to 2:30 pm, Monday through Friday. The average length of stay is between 4 to 6 weeks. Our program is the only senior-specific partial program in the metro Atlanta Area as well as the only one to provide free transportation to and from the facility.

In addition to the PHP program, we have also launched an IOCP (Intensive Outpatient Counseling Program) in September 2014. This is a 3 day program (Monday, Wednesday, Friday) in a less intense setting than PHP, where patients can attend for up to 36 treatment days (roughly 3 months). This program takes the concepts learned in PHP and teaches patients how to apply and use them in their daily lives. A patient does not have to go to PHP in order to join. Patients do need to provide their own transportation for this program. IOCP is Monday, Wednesday, Friday from 11:30am to 2:15pm.

I am proud to say I work in the Transitions Senior Program. The psychiatry department is thriving as PHP and IOCP continue to grow daily. If you are ever at Wesley Woods, feel free to stop by to speak to anyone on our team. We are on the first floor of the hospital, adjacent to the cafeteria. Both PHP and IOCP are housed in the same suite (B-1200). For more information on either program, please call 404-728-4776 or our program director, Ed Lawrence, at 404-728-6975.

We look forward to accommodating your geriatric psychiatry needs soon.

Repositioning the Psychiatric Service Continuum at Emory University Hospital at Wesley Woods

Adult PsychiatryThe National Alliance on Mental Illness (NAMI) projects over the next 25 years, we will witness the largest population increase in people over 60 years old in the history of mankind, in addition to a general population that will reach 400 million by 2030. The need for psychiatric services is also expected to increase during this period. These projections demand a review of how we provide psychiatric services.

As a result of this review, Emory University Hospital at Wesley Woods is proud to announce the launch of our new Adult and Senior Inpatient Psychiatry Programs. Our inpatient care model includes a diagnostic assessment, initial treatment and crisis stabilization to insure our patients safely transition from inpatient care to outpatient therapy. We also offer advanced treatments for psychiatric and mood disorders, including electroconvulsive therapy (ECT), Ketamine Infusions and Transcranial Magnetic Stimulation (TMS) – treatments that all may be continued after patients leave the hospital.

Our outpatient service offerings incorporate the Transitions Senior Program /Partial Hospitalization Program (PHP) & Intensive Outpatient Counseling Program (IOCP). We also offer general outpatient psychiatric care office visits. Additionally, we are also pleased to highlight the success of our recently launched 60+ Men’s Support Group. Our multi-specialty team of psychiatrists, residents, fellows, psychiatric nurses, licensed clinical social workers, licensed professional counselors; certified addiction counselors and mental health associates utilize best practices to treat a full range of psychiatric disorders.

Emory University Hospital at Wesley Woods has taken a creative role in developing, improving and increasing our psychiatric services for the next decade.

Stay tuned to see what is next!

Emory University Hospital at Wesley Woods
1821 Clifton Road, NE
Atlanta, GA 30329

For more information

  • Inpatient/ ECT/Ketamine/TMS: 404-728-6222
  • Outpatient Services: 404-728-4776