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For Immediate Release These articles are available for immediate release. As media professionals, please use these news releases to educate the public. We hope that you will find this a useful resource and we invite your comments and questions. If you need further information about the news release or other mental health topics, please contact: Karen Loihl
Was This Really the Decade of the Brain? I am struck by the attention the news media has given the Council Bluffs' mother who committed suicide by driving her car into the Missouri River, taking her three children with her. The articles state that this woman was suffering from depression, probably a very serious and deadly illness called Major Depressive Disorder. As a psychiatrist practicing in central Iowa for about 20 years, I have seen this kind of scenario all too often, as have all of my colleagues. Like many other illnesses, fatalities occur no matter how excellent the medical care the persons receive. Twenty per cent of people who suffer from depression die by suicide. Even though the majority of patients with major depressive disorder can be treated very effectively, about five percent of people with this disorder don't respond to any treatment including medications, psychotherapy, or electroconvulsive therapy. This does not mean that a person who has a resistant depressive illness is uncooperative, instead, it means that no matter what treatment is given, the person's brain disorder does not respond, just as there are forms of cancer that do not respond to current treatments. The news articles suggested that the state mental health system failed the Council Bluffs' woman because of early discharges from the hospital. I have not reviewed the records and thus cannot say that this is so in her particular case, but I do know that insurance does not cover as long a hospital stay as it did a few years ago. In my practice, which is only outpatient now, I am concerned about the number of patients I refer for hospitalization, who return from their hospital stay and are not much improved, if improved at all. Often the person's health insurance only covered a few days in the hospital. Most people can't afford to pay a hospital bill out of their own pocket, so they choose to go home without improvement if the insurance company stops payment. Research shows that it usually takes two or three weeks for medication to help depression, so allowing only three or four days of inpatient care for severely ill patients does not seem prudent. In the past few years there have been stories of people committing suicide after being discharged under these circumstances. I am also very concerned because the availability of mental health services in Iowa seems to be decreasing rapidly. For instance, some mental health centers have closed in the last few years because of lack of funds. In my own county in the last five years, we have seen the closing of an in-patient psychiatric unit, the closing of a hospital day treatment program, the departure of several psychiatrists including the only child psychiatrist, the closing of an intermediate care unit for the mentally ill, and just recently the closing of a care facility which housed several mentally disabled people. In surrounding counties several similar facilities have closed. I believe that passing Senate File 69 a few years ago contributed to these closures. Senate File 69 introduced a whole new level of bureaucracy allowing counties to decide which mental health services they will support. While county administrators feel the state should shoulder the financial burden of mental health care, there is not a mechanism in the state structure that allows the state to take over these services. As a result, neither county nor state government currently is willing to underwrite the cost of mental health services, and the whole system has deteriorated. State and county officials often say that mental health providers aren't cooperating because they won't provide free services or accept greatly reduced fees as often as they would like. However, like anyone else, there is limit to how much providers can decrease fees or provide free services before they themselves are forced out of business. The 1990's were supposed to be the decade of the brain. In fact there have been great advances during this decade in our understanding of the brain and the illnesses that afflict it, and in treating these illnesses. However, while science has gone forward, the system for funding the distribution and application of this knowledge has gone backward. In my opinion the ability to treat illnesses that were untreatable several years ago is the greatest cause of the increased cost of medical care. It's much less expensive to send ill people home, saying they are untreatable, than giving them expensive medications, granting frequent costly psychotherapy or hospitalizing them. However, governments, employers, insurance companies, and consumers have not adequately addressed the problem of paying for the ability to treat the many more illnesses that weren't treatable just a few years ago. How does this apply to the woman in Council Bluffs? Her case points to the tragic consequences that can result when mental illness is not successfully treated. Mental illness can be very serious, and even fatal, and isn't going to go away just because business and government authorities don't want pay for it. Unless insurance companies, governments, and the community as a whole confront the decline of mental health services and the problem of funding such services, I suspect we will see more cases like the Council Bluffs tragedy. Jerry Lewis,
MD, FAPA
One illness that is becoming more common because of our older population is not often talked about. That illness is dementia. The term dementia encompasses a group of illnesses in which an individual's mental abilities deteriorate or are lost. This loss can be gradual as in Alzheimer's disease or sudden as in infarct dementia (the form of dementia that results from strokes). Because there are some forms of dementia that can be treated very effectively, it is important to do a medical investigation, including blood tests and brain scans, to see whether a treatable form of the disease is the cause of the dementia. The most common kind of dementia is Alzheimer's disease, named after its discoverer. Alzheimer's affects one percent of the population above age 65, two percent over age 70, with the rate doubling each additional five years, but it can strike as early as the mid forties. The disease starts rather slowly and affects recent memory first. In the early stages of Alzheimer's all tests including brain scans are normal. Many people who experience memory problems wonder if they have the beginning of Alzheimer's disease. As a rule of thumb if a person knows he or she is having memory trouble, then they probably do not have Alzheimer's disease. Usually people with Alzheimer's disease aren't aware they are having memory problems. Some people with Alzheimer's have hallucinations. One of the more common forms of hallucination is seeing little people in their homes or back yards. Some people become very agitated and belligerent in the later stages and are unable to care for themselves. The diagnosis of Alzheimer's disease is made by knowing the history of the person's symptoms and doing medical tests to rule out other causes of dementia. The diagnosis can only be confirmed at death when a biopsy of the brain is done. However, psychological testing can be very helpful in the diagnosis. Psychological testing is very similar to IQ testing and thus one can measure a person's present level of intellectual ability and compare that with what would be expected from the person previous level of functioning in life. The cause of Alzheimer's is not known, but there appears to be a genetic factor. A person is much more likely to get the illness if they have a parent with the illness. Another clue is that people with trisomy 21, which is a genetic disease, almost always develop Alzheimer's after age 40. Treatment of Alzheimer's disease is just in its infancy. Three medicines now available have been shown to slow the progress of the illness. Giving one large group of people with the illness the medicine, and comparing it to another group who did not receive the medicine have proved their effectiveness. For this reason it is hard to know if the medicine is having an impact on an individual, since how fast the disease would have progressed without the medicine is not known. If a person is hallucinatory or agitated, there are other medications that can control those symptoms. The most definitive treatment is placing a person in supervised care where someone is with them to be sure their needs are met and that they stay safe. The second most common form of dementia is infarct dementia caused by having continual small strokes. Sometimes it is hard to separate infarct dementia from Alzheimer's disease, but the onset of infarct dementia is more abrupt, and the effects of strokes can often be seen on the brain scans. Controlling high blood pressure and giving blood thinners such as aspirin can slow down this illness. The progression of this dementia isn't nearly as regular or predictable as with Alzheimer's, and many times Alzheimer's disease and infarct dementia occur together. There are many other causes of dementia. Alcoholism is one of the most common and this dementia can be very severe. Low thyroid, vitamin B12 and folic acid deficiency, viral infections, and AIDS are just a few examples of other common causes. If you have a friend or relative who is showing signs of memory impairment and is beginning to show evidence of deteriorating function, then have them evaluated by a physician as soon as possible. The sooner the disease is diagnosed the more likely it can be slowed or reversed. Iowa Psychiatric
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