Student’s response to vaccination needle results in criminal charges of threatening

Sadly, it’s not just the U.S. where we see schools over-reacting and criminalizing children’s behavior. Last month, Tamsin McMahon reported on a case in Canada:

Police say they take school threats seriously — so seriously they charged a 12-year-old boy who threw a tantrum in his elementary school because he didn’t want to take a vaccination needle.

Durham Regional Police said officials from Ross Tilley Public School in Bowmanville, an hour east of Toronto, called them around 12:30 p.m. on Wednesday. The school had been administering vaccinations for hepatitis B and a boy had become upset at the prospect of a needle.

While talking to school staff he “threatened to cause damage to the school,” police said in a news release.
Officers consulted with the Crown attorney’s office and charged the boy with threatening, a criminal charge police said was justified: “due to the age of the child and concerns over public safety.”

The boy, who cannot be named under the Youth Criminal Justice Act, made a verbal threat against the school, police spokesman Dave Selby told CTV.

Mr. Selby told the broadcaster that officers do have the discretion not to lay a charge but decided the alleged threat was serious enough to be considered criminal. “Police take all threats to teachers, administration and school students seriously and advise that anyone over the age of 12 could face criminal charges,” police said in a statement.

The boy faced a bail hearing Wednesday after police went over the situation with the youth’s family.

Serious threat? It’s not possible, is it, that the child was just phobic about needles, was it? And it’s not like people having a phobic reaction or in a panic attack might say anything to escape the terrifying situation, is it?

This was actually a teachable moment for the school. Even if the child wasn’t actually needle-phobic, he was clearly distraught and this was an opportunity for the school to understand the student better and help the student explore what to do when in such situations.  As an alternative,  could  the school just say okay and require the parent to arrange for any required vaccination with the child’s regular physician?

What a shame they chose to handle it this way.

Breathing therapy reduces panic and anxiety

ANI has a small article on Sify about some new research demonstrating the effectiveness of breathing therapy in reducing symptoms of panic and anxiety attacks.  The premise behind the approach is that normalizing breathing can reduce symptoms.

I’m delighted to see this research as normalizing breathing is an approach I’ve been incorporating in my clinical work for decades since I came to the conclusion that one thing all effective therapies for stress-related conditions seemed to have in common was that they altered breathing patterns towards more relaxed/normalized breathing.

Here’s the abstract from the new research study:

Respiratory and cognitive mediators of treatment change in panic disorder: Evidence for intervention specificity.
Meuret, Alicia E.; Rosenfield, David; Seidel, Anke; Bhaskara, Lavanya; Hofmann, Stefan G.
Journal of Consulting and Clinical Psychology, Vol 78(5), Oct 2010, 691-704.

Abstract

Objective: There are numerous theories of panic disorder, each proposing a unique pathway of change leading to treatment success. However, little is known about whether improvements in proposed mediators are indeed associated with treatment outcomes and whether these mediators are specific to particular treatment modalities. Our purpose in this study was to analyze pathways of change in theoretically distinct interventions using longitudinal, moderated mediation analyses.

Method:  Forty-one patients with panic disorder and agoraphobia were randomly assigned to receive 4 weeks of training aimed at altering either respiration (capnometry-assisted respiratory training) or panic-related cognitions (cognitive training). Changes in respiration (PCO₂, respiration rate), symptom appraisal, and a modality-nonspecific mediator (perceived control) were considered as possible mediators.

Results: The reductions in panic symptom severity and panic-related cognitions and the improvements in perceived control were significant and comparable in both treatment groups. Capnometry-assisted respiratory training, but not cognitive training, led to corrections from initially hypocapnic to normocapnic levels. Moderated mediation and temporal analyses suggested that in capnometry-assisted respiratory training, PCO₂ unidirectionally mediated and preceded changes in symptom appraisal and perceived control and was unidirectionally associated with changes in panic symptom severity. In cognitive training, reductions in symptom appraisal were bidirectionally associated with perceived control and panic symptom severity. In addition, perceived control was bidirectionally related to panic symptom severity in both treatment conditions.

Conclusion: The findings suggest that reductions in panic symptom severity can be achieved through different pathways, consistent with the underlying models.

To translate the above into a more reader-friendly mode: both cognitive therapy and breathing therapy are of possible benefit, and they have comparable results in terms of effectiveness. Only the breathing therapy, though, actually reversed some of the hyperventilation seen in panic and anxiety attacks.

Do you need capnometry or sophisticated technology to learn to regulate your breathing, though? In my opinion and experience: no. Learning and rehearsing diaphragmatic breathing can produce the type of benefit reported above. The “trick,” if there is one, is to treat this as any other skill: it requires practice to develop. Practice the technique daily so that you learn to go into a deeply relaxed state quickly. If a normal breathing rate for adults is 12-18 breaths per minute, I encourage people to try to slow down their breathing rate to about 6 breaths per minute, with more time spent exhaling slowly than inhaling (exhale twice as long as you inhale). Even if you can’t get to 6 breaths per minute, learning to breathe out sloooooowly and evenly is a skill that you can access when you start to feel stressed or anxious.

If you would like to practice a breathing-based relaxation technique, you can find some simple instructions on my main web site in the article called, “Relax!“

Event: Parent Training, Missouri

Seen in the Joplin Independent:

National Alliance on Mental Illness (NAMI) Joplin will hold a Family to Family Education Class beginning Thursday, Sept. 16, 2010. It is an 11 week course taught by trained family members for families of individuals with severe brain disorders (mental illness).

The curriculum focuses on schizophrenia, bipolar disorder (manic depression), clinical depression, panic disorder and obsessive-compulsive disorder (OCD). The course discusses the clinical treatment of these illnesses and teaches the knowledge and skills that family members need to cope more effectively. All course materials are furnished at no cost.

Classes will be held at the NAMI Joplin office at 2701 S. Davis Blvd., Joplin on consecutive Thursdays from 6-9 p.m. To register or get more information please call NAMI at (417) 781-6264.

Migraine headaches in Bipolar Disorder

Migraine headaches have been reported to be comorbid with Tourette’s Syndrome. Because Tourette’s is often comorbid with Obsessive-Compulsive Disorder (OCD), which, in turn, is often comorbid with Bipolar Disorder, it should not surprise anyone to find a significant co-morbidity between OCD, Bipolar Disorder, and migraine headaches, even though until now, there have been no controlled studies that indicate any significant comorbidity between OCD and migraine.

A recent study demonstrates that the rate of comorbidity may be even higher than some of us had thought: one out of every five patients with BP-I had migraine headaches while more than one out of every three patients with BP-II had migraine headaches. Bipolar patients who had comorbid migraine exhibited significantly higher rates of suicidal behavior, social phobia, panic disorder, generalized anxiety disorder, and OCD. Here’s the abstract from the study:

OBJECTIVE: In two related studies, we explored the prevalence of migraine and its associated clinical characteristics in patients with bipolar disorder (BD) as well as psychiatric morbidity in patients treated for migraine.

METHOD: The first study included 323 subjects with BD type I (BD I) or BD type II (BD II), diagnosed using the Schedule for Affective Disorders and Schizophrenia, Lifetime version (SADS-L) format, or the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID). Migraine history was assessed by means of a structured questionnaire. In a second sample of 102 migraine patients, we investigated current and lifetime psychiatric morbidity using the SADS-L. Statistical analyses were conducted using nonparametric analysis and log-linear models.

RESULTS: A total of 24.5% of BD patients had comorbid migraine; those with BD II had a higher prevalence (34.8%) compared to BD I (19.1%) (p < 0.005). BD patients with comorbid migraine had significantly higher rates of suicidal behaviour, social phobia, panic disorder, generalized anxiety disorder, and obsessive-compulsive disorder (all p < 0.05). In the sample of migraine patients, 34.3% had a current psychiatric diagnosis, and 73.5% had a lifetime psychiatric diagnosis. The prevalence of BD I was 4.9%, and 7.8% for BD II. DISCUSSION: Migraine is prevalent within the BD population, particularly among BD II subjects. It is associated with an increased risk of suicidal behaviour and comorbid anxiety disorders. Conversely, migraine sufferers have high rates of current and lifetime psychopathology. A greater understanding of this comorbidity may contribute to our knowledge of the underlying mechanisms of BD.

Reference:

Ortiz A, Cervantes P, Zlotnik G, van de Velde C, Slaney C, Garnham J, Turecki G, O’Donovan C, Alda M: Cross-prevalence of migraine and bipolar disorder. Bipolar Disord. 2010 Jun;12(4):397-403.

What’s the most disabling co-morbid condition for individuals with Tourette’s Syndrome?

Sometimes research confirms my impressions based on clinical experience, other times it surprises. Here is a press release from the University at Buffalo about a new study where the results might at first blush seem somewhat surprising, but may be accounted for by the age of the research participants:

An assessment of patients with adult Tourette syndrome (TS) to identify clinical factors that contribute to psychosocial and occupational disabilities resulting from the vocal or motor tics that define TS found that anxiety/panic disorder may be the most disabling psychiatric condition associated with the disorder.

The results of the study, based on the Global Assessment of Functioning (GAF) scale, will be used to identify patients who are more likely to have or develop significant disabilities related either to the severity of their tics, or to the psychiatric disorders associated with TS, such as obsessive-compulsive disorder, mood disorders and drug or alcohol abuse.

Results were presented today (June 17) at the 14th International Congress on Parkinson’s Disease and Movement Disorders, being held in Buenos Aires, Argentina, June 14-17.

David G. Lichter, MD, professor of clinical neurology in the University at Buffalo’s School of Medicine and Biomedical Sciences, is first author.

“Our study identified the most significant predictors of disability, says Lichter. “Now having identified these at-risk patients, we can follow them more closely and begin appropriate interventions as early as possible.”

Lichter also noted that the finding of anxiety/panic disorder as the most-disabling psychiatric disorder associated with TS was unexpected.

“The main surprise was that depression was not a major predictor of psychosocial or occupational disability in these patients,” says Lichter. “Depression has been identified as an important predictor of quality of life in TS.

Tics, both motor and vocal, are the primary symptoms of Tourette syndrome. Vocal tics are involuntary sounds, such as whistles, hums, or throat clearing. Complex vocal tics can be repeating words or phrases or involuntary swearing. Motor tics are muscle spasms, such as involuntary eye blinks, shoulder shrugs, repetitive kicking, head jerks, eye darts and nose twitches.

In most patients, tics wane after mid-to-late adolescence. However, the study data indicates that in those patients whose tics persist into adulthood, tic severity remains the primary factor contributing to global psychosocial and occupational disability, according to Lichter.

“In many TS adults, motor tics remain more enduring and prominent than vocal tics and, in our study, motor tics were more severe overall than vocal tics and were more closely correlated with GAF scale score,” says Lichter.

The study involved 66 patients — 45 male and 21 female — who had been followed for an average of 8.2 years at a UB-based TS clinic. They ranged in age from 20 to 80.

Results showed that nearly 32 percent were diagnosed with obsessive-compulsive disorder (OCD), while 62 percent showed OCD behavior. Nearly 29 percent had anxiety/panic disorder with another 21 percent exhibiting anxiety symptoms.

Prevalence of other TS-associated conditions were depression (16.7 percent), depressed mood (12.1 percent), bipolar disorder (12.1 percent), rage attacks and severe self-injury behavior (4.5 percent), childhood ADHD history (33.3 percent), adult ADD (18.2 percent), substance-use disorder (22.7 percent) and psychosis and restless legs syndrome (1.5 percent).

In the future Lichter and colleagues plan to collect prospective data on both quality of life and psychosocial and occupational functioning in TS patients.

“We will look more closely at the interactions of tic severity, mood disorders, substance abuse and social support systems and determine how these issues relate to personal and social/occupational adjustment,” Lichter says.

“We hope this information will help us improve the lives of our TS patients, especially those who are at highest risk for a poor outcome.”

Sarah G. Finnegan, MD, PhD, UB assistant professor of neurology, is co-author of the study.

Note that they are looking at adult occupational and psychosocial functioning. My hypothesis is still that ADHD is the most disabling co-morbid disorder for school-age individuals with Tourette’s Syndrome.

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