Posted by Dr. Vollmer on June 16, 2013
So, mental retardation is now intellectual disability and dementia is now a neurocognitive disorder. Old wine in new bottles. Mild Cognitive Impairment (MCI), has become mild NCD. Ditto. Why are we changing nomenclature? The cynic in me says, the ten years to produce DSM 5 had to yield change, whether it was good, bad or lateral. The more generous person in me says that it makes sense to broaden the notion that as one ages, one’s brain declines, sometimes at a slow rate, consistent with the aging process, and sometimes, tragically speaking, the brain has an accelerated decline, a phenomena we used to call dementia and now we call NCD. This accelerated decline has rumblings which perceptive patients and family members detect, and now we can label those rumblings as mild NCD. The theme of DSM 5 seems to be to create umbrellas and then deal with the details later. There is the autistic spectrum umbrella, the trauma and stressor related disorders umbrella, the obsessive compulsive umbrella and the neurocognitive decline or disorder umbrella. It reminds me of cleaning up a messy room, the first step is to make piles. There is the pile you want to give away. There is the pile to keep and the pile you are not sure what to do with. Breaking things down into piles makes the process of change less overwhelming. As such, DSM 5 feels like a temporary clean-up of psychiatry, leading the way to a more sophisticated understanding of the brain, downstream. Now, I want to take issue with the word neurocognitive. What is the difference between cognitive and neurocognitive? Is that not redundant? Sometimes cleaning up makes things messier.
Posted in Aging Brain, DSM 5, Geriatrics | 4 Comments »
Posted by Dr. Vollmer on March 26, 2013
Without connection, we die sooner. So, today’s article in the LA Times, tells us, as it reports from a published study in the Proceedings of the National Academy of Sciences. Sure, we want science to support what makes sense, so sure I support the study. I just hope it comes as no surprise. Emotional needs, like physical needs, are needs, and as such, when deprived, poor mental and physical states ensue. Without nutrition we die. Food is life-sustaining, and so are friends and family, if one feels that these friends and family can provide reciprocity and respect. This latter comment, is, of course, speculation. The study only shows in a gross way, how important people are to other people. I speculate further, that the interactions necessary to sustain life are those which bolster self-esteem and worthiness. Without these, the mind tells the body that life is less important and so there is less of a push for self-care. In other words, as we age, this mind/body connection is even more important, as the body becomes more vulnerable, the need for the mind to “fight” for the body’s survival is more critical. This “fighting mind” is fueled by feeling loved and valued by people deemed important. Some would argue that elderly people in communal living situations live longer because the support of the community helps them wake up each day and look forward to seeing their “friends’ whereas elderly folks who live alone have less incentive to push themselves towards activities. All this to say that “behavioral medicine,” as some call the specialty of mental health, really promotes the obvious-friendship. As I say many times in my posts, the answer is easy. The difficulty is in the execution.
Posted in Geriatrics, Loneliness, Media Coverage, Mind/Body | 8 Comments »
Posted by Dr. Vollmer on October 26, 2011
Max, eighty-five, just cheated on his girlfriend Beatrice, age eighty-seven. Max says “I just love Sophie (age ninety), so I had to let Beatrice go.” The guilt in Max’s voice is palpable. “Beatrice really loved me,” Max tells me, with what seems like is a mixture of uncomfortable feelings. “It seems like you have never found a woman that meets all your needs,” I say, referring to the fact that Max has never had a monogamous relationship. “I guess that is true,” Max says, with a sad and thoughtful tone. In this interchange, Max becomes sympathetic. He did not set out to hurt Beatrice, although he did hurt her very much. Max is trying to make himself feel whole, and in so doing, he has betrayed Beatrice. Max believes that Sophie is more suitable to him, even though in his lifetime, he has never found anyone who he felt was a good fit. On the one hand, Max gets a lot of credit for trying, despite his advanced age, to find his soul mate. On the other hand, after all these years, one might hope that Max could be more honest in his relationships. Max seems to understand this. He seems both proud of himself for finding a new partner and angry with himself for letting down Beatrice. It is too simple to say that Max is a “bad person” even though he has been consciously hurtful to others. His long life has shown that he repeats the pattern of falling in and out of love, humiliating the previous girlfriend each time. His awareness of his pattern brings up a stew of feelings which makes him alternate between elation and guilt. Max has children, but his love life dominates his mental existence. Maybe Sophie will be the one, he hopes.
Posted in Geriatrics, Guilt, Psychotherapy | 2 Comments »
Posted by Dr. Vollmer on October 25, 2011
Primary Care Physicians need to learn psychopharmacology; they also need to learn how to help people enhance their lives through behavioral change. This is the old saw: nature and nurture. The medications address the nature, the environmental change targets the nurture; both are important, at every stage of life. Consequently, I have taken a new route to training Family Medicine Residents to guide patients towards healthier, happier lifestyles. A physician recommendation is powerful. A friend or family member may suggest to their loved one to pursue a community resource, yet when this same suggestion comes from their doctor, there is often more impact. Further, when a physician has seen the resource themselves, they are more likely to explain the benefits in a way which is compelling. So, Monday mornings are now consumed with what I jokingly refer to as “field trips,” but more seriously refer to as “community medicine”. The Culver City Senior Center was our focus. My residents and I were overwhelmed by the scope and accessibility of all that they had to offer. There were computer classes, trips to museums (they were going to the Getty Villa that day), Tai Chi, and a knitting group. Lunch is offered, requiring a voluntary donation of a nominal amount. The physical, mental and social stimulation available was really exciting. My group bemoaned the fact that we did not make their age cut-off. If one patient a month follows through on the recommendation to expand their world by joining the Culver City Senior Center ($10.00/year), then I have done my job, both in terms of helping residents understand community resources to improve mental health, and in terms of helping patients improve their physical and mental well-being. My “field trips” are win-win-win. I “win” because I expand my world of social services. The residents “win” because they are shown experiences which can’t really be described, they have to be seen. The patients “win” because they are given recommendations which can potentially improve the quality and the duration of their lives. A triple gain-not bad! Sometimes nurture is underrated.
Posted in Geriatrics, Medical Training | 2 Comments »