I just finished presenting four talks for the Pensylvania State Emergency Medical Services (EMS) conference in Harrisburg.

I spoke about

• Dealing with Emotions During Emergencies
• Dealing with the Angry Person and Preventing Escalation
• Dealing with the Confused Person
• Managing the Hysterical Patient.

Watch my site for postings on some of these topics.

 I want to share some of this great experience. First of all the people. All those who attended my workshops seemed truly interested in learning how to help their patients deal with the emotional stress of emergencies.  They were open to new ideas and had lots of experience and ideas themselves about what worked to calm people down.

I was pretty concerned  when I read this Time article about soldiers being medicated for burnout or compassion fatigue or stress and many other psychological concerns.

How can any thinking human being be in a battle zone, risking their life and seeing others killed not be distressed?  We are fooling outself if we think this is possible.  To  think that an antidepressant will help this kind of sadness and distress is just naive.  I am sure the prescribers know better.

My bigger concern in this article is the mention of Clonazepam (Klonopin) for anxiety and Ambien for sleep.

   Buried at Work? 

I found an online article listing questions parents should ask before considering psychiatric hospitalization for their children.  I think there are some qood questions here, but I would like to add my 2 cents to certain questions. 

In the spirit of full disclosure I am a Psychiatric NP with many years experience including inpatient units. Psychiatric admissions and hospitalizations have changed dramatically in the last 20 years. What used to be for weeks even months is now days.

There is a long complicated article in the NY Times today about suicide and impulsivity that is worth a read (if you can manage it.)

“Suicide autopsy” studies can give us lots of information, but no one really knows what goes through the head of a person just before he or she dies from suicide, it may be regret as suggested by one person interviewed by the author.

There are a few comments I would like to make about the article and suicide in general that are based on my own years of experience, and thoughts. If you can’t get through the article hopefully they will still make some sense to you.

Question and Answer Post

From a Reader named “Mary”

Please help me! I have been in a relationship with my live in boyfriend about 3 yrs. He is like having another child around. He does not help with things and expects me to take care of everything. He has a bad temper and although he has never hit me when he gets angry he breaks things. I want to end this relationship but when I tell him that he says he can’t live without me and will kill himself if I go. I’m scared! I don’t know what to do. I cry all the time and can’t sleep well at night.

There is a terrific article in the NY Times today that is a must read for everyone who will eventually die (that’s you & me). It talks about the “you must fight” attitude many of us think we should have and expect of other people when they are very ill.  Is this the best for them and us?

An article in today’s NY times about a doctor who offered to pray with a patient brought a variety of responses that covered the entire gamet from suggestions of taking his license away to nominating him for sainthood.

I thought about this because the use of prayer, religion or other spiritual practices has been a topic of many conversations by patients in my psychotherapy practice over the years. I usually say something like “if it helps you or brings you comfort its fine”. However, no one has ever asked me directly to pray with them. I can imagine this could happen especially during a crisis or emergency. As a matter of fact, it is a wonder I have avoided it so far. This article made me wonder what my answer would be to such a request.

Take a look at this  NY Times story  on this crisis about  a third suicide by a teenager in the last year on Nantucket Island. It is a sad story. What struck me is the fact that the “experts” don’t agree and are not always helpful.

We need to realize that we have very few answers to this and many other Mental health questions.  We also are not paying much attention or doing much research in this area.  Mental health care often has sparce coverage by insurance companies. In this country our attention is often on other things:  money, possessions, power. Our educational system training “experts” is lacking to say the least.

The recent story in the NY Times about a psychiatrist who was stabbed to death

and another who was critically injured brings up many fears about the mentally ill. It is a horrible very sad event, but it is important to keep in perspective the facts regarding mental illness and violence. Here are the numbers that may help to do that.

Violence in male persons with schizophrenia is 5.5% higher then in the “normal population”

Violence in women with schizophrenia is 5-9 times higher. (Women have much less violence rates to begin with)
Persons with Schizophrenia who are violent are most often off their medication and psychotic (hearing voices or delusional)