Marlene B. Huff

A Broken Heart—The Physician’s Role: Bereaved Parents’ Perceptions of Interactions with Physicians

This survey study provides pediatricians the opportunity to hear directly from surviving parents and caretakers and is an initial step in developing training curricula for doctors and other health care professionals who wish to improve the effectiveness of their interactions with grieving families. A privately maintained listserve, originating in Kentucky, of bereaved parents and guardians was used to send written surveys via the U.S. Postal Service to those individuals living in Kentucky. Survey results include thematic concerns identified by the bereaved parents about physician interaction and actions at the time of a childs death. Although published guidelines are available for physicians attending to bereaved parents at the time of a childs death, these results suggest that the availability of guidelines alone may be insufficient and that more in-depth physician training and education are needed.

Clinical Management of Adolescents with Autism

Autism spectrum disorder is a spectrum of neurodevelopmental disorders that includes autistic disorder and pervasive developmental disorder-not otherwise specified. This article provides the reader with an overview of the major psychosocial issues related to adolescents with autism. This discussion is followed by an interjection of medications that may be useful in maximizing the functioning of adolescents with autism.

Holistic Health: Does It Really Include Mental Health?

Holistic health, incorporating mind and body as equally important and unified components of health, is a concept utilized in some health care arenas in the United States (U.S.) over the past 30 years. However, in the U.S., mental health is not seen as conceptually integral to physical health and, thus, holistic health cannot be realized until the historical concept of mind-body dualism, continuing stigma regarding mental illness, lack of mental health parity in insurance, and inaccurate public perceptions regarding mental illness are adequately addressed and resolved. Until then, mental and physical health will continue to be viewed as disparate entities rather than parts of a unified whole. We conclude that the U.S. currently does not generally incorporate the tenets of holistic health in its view of the mental and physical health of its citizens, and provide some suggestions for changing that viewpoint.

Mental Health Corner

2009 North Ame Published by Elsev Increasingly, reproductive care providers are placed in the precarious position of meeting the medical needs of depressed adolescents who need to take antidepressants in order to manage their condition, but become pregnant. Adolescents, just like many reproductive care providers, are asking the question, ‘‘What are the risks and benefits for me and my baby if I continue to take antidepressants throughout my pregnancy?’’ This question has a complex answer and, many will argue, has yet to be fully examined in the scientific literature. Not only does the United States have the highest adolescent birth rate among all developed nations, but depression is estimated to affect from 8% to 25% of all females over one’s lifespan, with the peak number of depressive episodes occurring during the childbearing years. Almost one third of first-time adolescents will have a repeat pregnancy within two years. Given these rates, reproductive care specialists will, at one time or another, be faced with an adolescent pregnant female and her medicationdthe point at which the health of the mother and the health of the baby intersect for, perhaps, the first time. The worst outcome of adolescent depression, of course, is suicide. Suicide is the fourth leading cause of death in people under the age of 20 and, for the first time in many years, the suicide rate is increasing among this age group. It is clear that adolescents whose depression is not being treated are at a higher risk for depression than those who are taking appropriate and effective medication. Even in circumstances where untreated depression does not end in suicide, there are serious negative outcomes for the mother and the baby. These negative consequences include poor maternal nutrition, increased use of drugs and alcohol, preterm delivery, and small infant size. In this issue of the journal, by Dr. Kimberly McClanahan, from the University of Kentucky, addresses this important topic which is interest for many reproductive health care specialists. In addition to providing an excellent and timely literature review illustrating what is known about antidepressant use during pregnancy and the differences of such medication use in various stages of pregnancy, she is able to provide practice recommendations for all of us who find ourselves balancing the use of medications for the mother with the health of the soon-to-be-born baby during a delicate time of development. Marlene Belew Huff, LCSW, PhD Section Editor

From Healing the Whole Person: An Argument for Therapeutic Touch as a Complement to Traditional Medical Practice

The growing popularity and use of therapeutic touch (TT) is an issue that has generated controversy and concern within the medical community. While anecdotal and traditional scientific evidence suggest that TT would be an advantageous addition for clinics and hospitals to include in their armamentarium of complementary interventions within the realm of traditional medicine, TT has not become widely available in the U.S. One reason for the lack of availability may be the dearth of conclusive scientific support for TTs efficacy and, therefore, its inclusion in clinic and hospital treatment planning would give it the appearance of legitimate practice, which it may not yet deserve. Whether or not deserved, if TT were added to hospital and clinic treatment protocols without substantial scientific support, it would be thought to have the implicit support of the scientific community, at which point the question of its efficacy would be moot in the minds of many people; thus patients would utilize it, because they believe it works rather than because it works. Since TT has not yet been scientifically proven as per Western standards, leaders of the health care community are likely wary of lending support to TT at this time. If TT can be found to be a scientifically sound therapeutic technique, then it will be more readily accepted in the health care community. This paper reviews TT.

Incidence of Galactorrhea in Young Women Using Depot-Medroxyprogesterone Acetate

Galactorrhea is rarely mentioned as a possible side effect of the use of Depot-Medroxyprogesterone Acetate (DMPA). Over the last few years, we have noticed an increased number of patients complaining of galactorrhea. A review of clinical data showed that between 1999 and 2005, 360 adolescents in our clinic used DMPA for at least 6 months. After medical follow-up, 13 (3.6%) of these patients were found to have developed galactorrhea. The mean age of the patients was 19.4 years with a range from 13—24. Prolactin levels in these patients were normal, and in all subjects, the galactorrhea resolved spontaneously within the next year in both patients who continued use and those who discontinued use of DMPA. It appears that galactorrhea is a benign side effect and as previous reports have suggested, it did not seem to be related to changes in Prolactin levels in our patients. It is thought that this is a progesterone-mediated effect. We believe that reassurance and education of patients is sufficient and there is no evidence of need for further intervention. Since the sample size is small in this study, additional research is recommended as to validate the presence of progesterone-mediated effects secondary to the use of DMPA.

Video Self-Modeling in Mood-Based Disorders

Abstract Based on the assumption that thoughts and behaviors are interrelated, techniques of video self-modeling provide potential for people to learn from images of their own adaptive behavior. Self-modeling is an intervention procedure using the observation of images of self-engaged adaptive behavior to affect the symptoms of depression. The essence of video self-modeling is the display of non-depressed behavior appropriate for analysis in therapy. These images are captured on video and edited into 2–4 minute vignettes, and repeatedly reviewed to improve image, self-presentation and confidence among persons with mood-based disorders. The purpose of this activity is to promote a “positive image” in and of itself and to, in turn, encourage positive changes in behavior. Mildly or moderately depressed people can be prompted to recognize circumstances or events pleasant enough that, during their recounting, these individuals expressed non-depressed behaviors.