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Psychoneuroendocrinology - Endocrine Psychiatry


Barbarannamated
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I wasn't sure where to put this. I do not know this doctor, but find his explanation interesting (except for the bioscience tie).

 

Psychoneuroendocrinology.com

 

http://www.psychoneuroendocrinology.com/clinicalrelevance.html

 

Clinical Relevance

 

Many patients, whether medical patients or psychiatric patients, feel they are receiving suboptimal care and feel their hormones are somehow playing a role in their illness, and yet this is commonly ignored in their treatment.

 

Patients often sense that they have a chemical imbalance. Appropriate endocrine testing can rule out subtle endocrine influences that may play a role in their illness. The mind/body dichotomy is never more apparent than in dealing with illness effecting the brain. Obviously, so called physical illness coexists with psychological illness so frequently that it is the rule rather than the exception. When one has a heart attack it may be initiated by neuroendocrine changes triggered by psychological events originating in our brains and propagated to end organs, including the heart. It is virtually never mind OR body; it almost always is a mind/body event. So ignoring the psychological elements of illness sometimes leads to inadequate medical care. My goal is to integrate the mind/body in a comprehensive approach to the patient's care. Therefore, during an interview we may switch from psychological to physical in a split second with no thought to that shift. After all, our mind/body knows of no such split.

 

Endocrine psychiatry is particularly relevant to understanding the perimenopause and menopause. Part of this understanding includes considering hormone replacement therapy with bio-identical hormones as a therapeutic option after considering the patient's genetic, family and medical history. When hormone replacement therapy is contraindicated, other treatments are often an effective alternative. For information about other treatments, vitamins, and nutraceuticals visit farmacopia.net.

 

Endocrine psychiatry is playing an increasing role in the diagnosis and treatment of mood and anxiety disorders. The study of the hypothalamic-pituitary-adrenal axis has become a fertile area of investigation in studying psychiatric disorders. Cortisol, an adrenal hormone, is frequently elevated in depression. This has led to the Dexamethasone Suppression Test that is positive in 50% of clinical depressions, and most melancholic depressions. The regulatory factors involved in cortisol secretion, including the hypothalamic hormone, CRF, are being studied as starting points for the identification of CRF receptor antagonists, which may become useful antidepressants. (See Neurocrine Biosciences). Prolactin is a pituitary hormone that is a useful marker of neuroendocrine dysfunction. Its elevation can lead to suppression of menstrual periods and associated psychiatric illness. Premenstrual depression is another neuroendocrine mediated disorder that is being carefully studied (see Psychoneuroendocrinology. p. 245). The role of stress in many disorders is an active area of investigation in psychoneuroendocrinology. One of the stress disorders, posttraumatic stress disorder paradoxically is associated with a low serum cortisol. The thyroid disorders including hypothyroidism and hyperthyroidism commonly occur, or are causative factors, in mood disorders and should be ruled out in any complete evaluation of depression or mania. Vitamin deficiencies can provoke depression in susceptible individuals, and therefore screening for B12 and folic acid deficiency should be a part of the evaluation of mood disorders. Finally, in men a low testosterone level can be associated with a clinical depression with decreased libido, and therefore should be ruled out in men presenting with a mood disorder.

 

REFERENCES

 

Shorter, Edward, & Fink, Max. (2010). Endocrine psychiatry. Oxford Univ Pr. Wolkowitz, Owen, & Rothschild, Anthony. (2003). Psychoneuroendocrinology. American Psychiatric Pub.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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I wasn't sure where to put this. I do not know this doctor, but find his explanation interesting (except for the bioscience tie).

 

Psychoneuroendocrinology.com

 

http://www.psychoneuroendocrinology.com/clinicalrelevance.html

 

Clinical Relevance

 

Many patients, whether medical patients or psychiatric patients, feel they are receiving suboptimal care and feel their hormones are somehow playing a role in their illness, and yet this is commonly ignored in their treatment.

 

Patients often sense that they have a chemical imbalance. Appropriate endocrine testing can rule out subtle endocrine influences that may play a role in their illness. The mind/body dichotomy is never more apparent than in dealing with illness effecting the brain. Obviously, so called physical illness coexists with psychological illness so frequently that it is the rule rather than the exception. When one has a heart attack it may be initiated by neuroendocrine changes triggered by psychological events originating in our brains and propagated to end organs, including the heart. It is virtually never mind OR body; it almost always is a mind/body event. So ignoring the psychological elements of illness sometimes leads to inadequate medical care. My goal is to integrate the mind/body in a comprehensive approach to the patient's care. Therefore, during an interview we may switch from psychological to physical in a split second with no thought to that shift. After all, our mind/body knows of no such split.

 

Endocrine psychiatry is particularly relevant to understanding the perimenopause and menopause. Part of this understanding includes considering hormone replacement therapy with bio-identical hormones as a therapeutic option after considering the patient's genetic, family and medical history. When hormone replacement therapy is contraindicated, other treatments are often an effective alternative. For information about other treatments, vitamins, and nutraceuticals visit farmacopia.net.

 

Endocrine psychiatry is playing an increasing role in the diagnosis and treatment of mood and anxiety disorders. The study of the hypothalamic-pituitary-adrenal axis has become a fertile area of investigation in studying psychiatric disorders. Cortisol, an adrenal hormone, is frequently elevated in depression. This has led to the Dexamethasone Suppression Test that is positive in 50% of clinical depressions, and most melancholic depressions. The regulatory factors involved in cortisol secretion, including the hypothalamic hormone, CRF, are being studied as starting points for the identification of CRF receptor antagonists, which may become useful antidepressants. (See Neurocrine Biosciences). Prolactin is a pituitary hormone that is a useful marker of neuroendocrine dysfunction. Its elevation can lead to suppression of menstrual periods and associated psychiatric illness. Premenstrual depression is another neuroendocrine mediated disorder that is being carefully studied (see Psychoneuroendocrinology. p. 245). The role of stress in many disorders is an active area of investigation in psychoneuroendocrinology. One of the stress disorders, posttraumatic stress disorder paradoxically is associated with a low serum cortisol. The thyroid disorders including hypothyroidism and hyperthyroidism commonly occur, or are causative factors, in mood disorders and should be ruled out in any complete evaluation of depression or mania. Vitamin deficiencies can provoke depression in susceptible individuals, and therefore screening for B12 and folic acid deficiency should be a part of the evaluation of mood disorders. Finally, in men a low testosterone level can be associated with a clinical depression with decreased libido, and therefore should be ruled out in men presenting with a mood disorder.

 

REFERENCES

 

Shorter, Edward, & Fink, Max. (2010). Endocrine psychiatry. Oxford Univ Pr. Wolkowitz, Owen, & Rothschild, Anthony. (2003). Psychoneuroendocrinology. American Psychiatric Pub.

 

It makes more sense than chemical imbalance in the brain. I know what I get like when my blood sugars go through the roof or go ceasing through the floor. The same with my late mother. I used this line to convince my psychiatrist I need off antidepressants, since my body chemistry was screaming this to me. People I talk to on some of the other depression support boards have similar experiences. One lady I talk to in South Africa has problems when lupus rears its head in her. Barb, you said yourself, you have had issues with thyroid in the past. Several others here have had similar problems. It's just the majority of doctors are either too damn incompetent or too damn lazy or, in the case of a friend of mine who is an md in Texas (and a fine one at that. I've known this guy sine he was10 years old. He was a damn fine saxophonist and vocalist in the Dallas/Ft. Worth area before he went to med school) is hamstrung by insurance.

History:

1995--Prozac--Quit CT by GP

1995--Effexor--Quit per my GP

1996--Amitriphene--Quit CT when changed GP

2005--Citalopram and BusPar. Prescribed when I decompensated in my GP's office. GP referred me to behavior health. Psychiatrist prescibed these drugs. Taken off citalopram in 2011 due to FDA warning. Quit Buspar during transition to viibryd.

Viibryd--2011 to present. Had a severe reaction in March 2012. Advised both GP and Psychiatrist I was trying to get off these drugs.

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It is virtually never mind OR body; it almost always is a mind/body event. .

 

This is the reason I prefer osteopaths and integrative MDs over allopathic MD's.

History:

1995--Prozac--Quit CT by GP

1995--Effexor--Quit per my GP

1996--Amitriphene--Quit CT when changed GP

2005--Citalopram and BusPar. Prescribed when I decompensated in my GP's office. GP referred me to behavior health. Psychiatrist prescibed these drugs. Taken off citalopram in 2011 due to FDA warning. Quit Buspar during transition to viibryd.

Viibryd--2011 to present. Had a severe reaction in March 2012. Advised both GP and Psychiatrist I was trying to get off these drugs.

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NOTE: major pharma shill (Nemeroff) on Board of International Society for Psychoneuroendocrinology (ISPNE) *sigh*

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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By claiming to practice psychoneuroendocrinology, psychiatrists can cover all the bases and not have to change that "chemical imbalance" claim.

 

Yes, there are endocrine illnesses that affect the nervous system (that's the "neuro" part) -- in fact, ALL of them do. Emotions, thoughts, and perceptions may be altered by the activity of endocrine hormones. (That's the "psycho" part.)

 

However, treatment of the endocrine imbalance is what's needed, not to pour on endocrine treatment for the "neuro-endo" part plus psychiatric drugs for the "psycho" part.

 

You can see how psychiatrists "treat" PMS -- antidepressants.

 

Treatment of endocrine disorders requires a great deal of specialized knowledge. I would never trust a psychiatrist to do this.

 

(However, R.S. Isaac Gardner, M.D., the guy who authored the article Barb quotes, who owns Psychoneuroendocrinology.com does appear to be a qualified endocrinologist as well as a psychiatrist.)

 

I've talked to Wolkowitz himself about HPA dysregulation in withdrawal syndrome and it was a gross waste of time. He did not have a clue, or none he would share with me. Nice guy, though. He was involved in Schatzberg's research into mifepristone (RU-486, the "abortion pill") for depression. Schatzberg at the time had started a company to market it; this caused him to get censored by Stanford for conflict of interest.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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Always interesting to learn how their beliefs translate into everyday practice.

 

I found this yesterday when a friend said that she'd had neuro problems and endocrine problems but never heard of them being related. :o

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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