Postpartum Depression

Postpartum depression is a mental health condition which emerges within four weeks of childbirth, and includes symptoms of depression, anxiety, irritability, mood fluctuations, insomnia, cognitive changes, as well as low self-esteem, difficulty coping, guilt, and possibly suicidal ideation (DSM-IV-TR).  This condition affects 10 to 13 percent of postpartum women, and a history of postpartum depression increases the risk to 25 percent (Misri, & Kendrick, 2007; Wisner, Parry, & Piontek, 2002).

It is likely that the incidence of postpartum depression is underestimated because many women suffer in silence; for example, in one study, only one-third of women who were diagnosed with postpartum depression believed that they were suffering from it, and over 80 percent had not reported their symptoms to any healthcare professional (Lee, 2006).

It has been found that postpartum depression negatively impacts mother-infant bonding and compromises infant’s social, behavioral, and cognitive development (Amankwaa, 2003; Milgrom, Ericksen, McCarthy, & Gemmill, 2006).  More specifically, it often affects the mother’s availability and sensitivity to the child, increasing the likelihood of the infant developing insecure attachments (Herring & Kaslow, 2002; Hoffman, 2006).  In stressful situations, these children often demonstrate comfort- and proximity-seeking behavior (Bowlby, 1988).

The parenting style of depressed mothers is often characteristic of conflict avoidance and submitting to their child’s non-compliance (Beck, 1999).  Their attempts to stop their children’s inappropriate behaviors or enforce consequences for misbehavior are often ineffective.

Postpartum depression is a physiologic response to hormonal changes , which is exacerbated by sleep deprivation, nutritional changes, and the stress of the new role (Wisner, Parry, & Piontek, 2002). Some research suggests that hormonal factors are primarily responsible for the onset of low mood in the first few weeks after delivery, whereas psychosocial variables play a more important etiological role in postpartum depression with later onset (Hipwell, Reynolds, & Crick, 2004).  These psychosocial variables include a previous psychiatric history, depressed mood during pregnancy, previous consultation with a doctor regarding a mental health condition, and inadequate social support (Hipwell, Reynolds & Crick, 2004, p. 212).

In psychotherapy, a psychologist can help effectively address cognitive, behavioural and affective symptoms of postpartum depression.

Chronic Pain & Chronic Pain Management

Chronic pain touches all aspects of a chronic pain sufferer’s life; work, family, recreation, sleep, self-image, cognitive abilities and mental health are often affected by the pain experienced.  The sad, common scenario is of a person who had a normal, satisfying life before the pain experience struck and changed his or her life.

Fortunately, there are many chronic pain treatments which successfully help in taking control of chronic pain.  Chronic pain intervention has been demonstrated over and over to be beneficial in many ways to the pain sufferers for example; in reducing medication intakes, improving the chronic pain sufferer’s quality of life (social, family and work), improving the chronic pain sufferer’s sense of self-worth and reducing the distressing symptoms of pain. Chronic pain management and chronic pain treatment are ongoing processes addressing most if not all aspects of the pain sufferer’s life. The chronic pain sufferer may feel depressed, anxious, at time suicidal. Pain treatment is essential in supporting, motivating and guiding the chronic pain sufferer toward improving his or her ability to cope with chronic pain.

Our office can provide diagnostic and personalized treatment interventions for chronic pain (chronic back pain, low back pain, chronic joints pain, post-surgery related chronic pain). Individual pain treatment is essential in helping the chronic pain sufferer with the necessary personalized care chronic pain conditions often require. Over the years we have helped many chronic pain sufferers to cope with pain often in their own language – providing chronic pain treatment in Italian, French, Spanish and Russian.

Posttraumatic Growth

Posttraumatic growth is a positive psychological change, frequently involving finding meaning and purpose following a traumatic event, such as an accident (e.g. motor vehicle accident, work-related accident), personal injury, medial issues (e.g. surgery, cancer, heart attack), divorce, bereavement or assault (Joseph, Linley, & Harris, 2005).  It has been estimated that 40 to 70 percent of individuals who experience a traumatic event later report at least some positive changes resulting from their struggle with trauma (Calhoun & Tedeschi, 1999).

Posttraumatic growth is a consequence of new information being integrated intellectually as well as affectively, and results in changes in perception of self, relationships with others, and philosophy of life (Calhoun & Tedeschi, 2004; Calhoun & Tedeschi, 1999).  Five major areas of posttraumatic growth include seeing new possibilities, changed relationships, paradoxical view of being both stronger yet more vulnerable, a greater appreciation for life, and changes in the individual’s spiritual and existential domain (Calhoun & Tedeschi, 2004).

Some personality factors influence an individual’s ability to experience posttraumatic growth, such as openness to experience and optimism.  In psychotherapy, a psychologist can help an individual to create a narrative which integrates altered schemas and facilitates growth.

Trauma

Unfortunately, trauma touches many of our lives.  Many of us have experienced traumatic events such witnessing or being subject to a fearful or life-threatening situation during which we may feel helpless or fear for our lives.  Some of these events may include war, a natural disaster, an accident or physical or emotional abuse.

Although we all react differently to traumatic situations, some experiences are quite common and include anxiety, fear, worry, sadness, flashbacks, sleep difficulties, avoidance of triggers, recurring thoughts of the event, feeling as though the event is happening again, feeling overwhelmed and helpless, problems concentrating and being easily startled, to name a few.  Some people may even go on to develop Post-traumatic Stress Disorder (PTSD).These symptoms can be very distressing and make it difficult for people to function at work, home, school or in a social environment.

Through trauma treatment programs (either individually or in a group) healing from trauma can begin.  At the Centre for Psychological Assessment, Treatment and Education, we offer treatment for PTSD.  We work from a Cognitive Behavioral framework and provide evidence-based trauma therapy which includes psychoeducation about the symptoms one is experiencing, understanding thoughts, feelings and behaviours and how these are connected to the traumatic event.We identify, explore and challenge negative thoughts and develop a repertoire of skills to cope with the negative feelings and physiological experiences.  We also assist the client in learning relaxation strategies and in developing a hierarchy of feared places, objects or situations and, through a process called systematic desensitization, assist them in approaching these places, objects or situations with reduced anxiety. Through these methods, trauma healing can begin.

Ashley Smith; homicide or a life that could have been saved

Ashley Smith, the 19-year-old who committed suicide at Grand Valley Institution in Kitchener, Ont., in 2007 has shocked Canada and raised many questions on how we deal with people with find annoying, obnoxious, shocking, needy or who simply we do not like.

What is particularly distressing about Ashley Smith’s death is that she was in custody where people in charge had many opportunities to intervene and save her life; it simply did not happened.

Ashley Smith’s life could have been saved like probably many others we do not even know about. Canada, one of the most socially, financially, legally and technologically advanced country on the planet did not do the right thing in Ashley Smith’s case, as simple as that. This is particularly disturbing especially in light of the scientific knowledge Canada has produced in the last 20-30 years. In the field of assessing and finding effective intervention for the rehabilitation of people in trouble with the law Canada leads the way. Without bragging Canada is at the forefront of knowledge, bar none, not even our cousins down south; or better, for a long time we were ahead of the game, now the doubt that we are losing ground is making us uneasy.

I have been in and out of jail since 1989; I am not a jail-bird, I work with people in trouble with the law, from the moment they are charged to the moment their sentence is over. I have worked with young offenders, male and female residents, low and high risk and mentally disturbed people. What strikes me as most upsetting about the recommendations made by the coroner Julian Falconer in the wake of the unfortunate death of Ashley Smith is how these recommendations could be easily transferred to any other class of incarcerated people in Canada (young offenders, male residents, elderly, mental health people in custody). It this would be the case, everybody who has been exposed to the world of rehabilitation would say something like; “Finally!!!!! They woke up!!!!”

People in trouble with the law face problem which do not stop at the prison’s gate (as the recent DSM-V seems to recognize); once in the community most of the people in trouble with the law present with special needs; our societal response is not to help them, but to create a vacuum around instead. Again this is an ongoing source of frustration for people involved in rehabilitation; in spite the dedication and commitment of thousands of private and governmental workers, the support available in my experience is simply insufficient.

We are a society that thinks the world should work like a supermarket; as you need bread, milk, soap, you walk into a supermarket and ten minute later you come out with what you need; unfortunately the supermarket mentality cannot be used when the issues are more complex than picking up milk or soap.

Quick fixes are not a viable option in cases in which mental health, rehabilitation, incarceration, poor social support and special needs meet.

As a society we know what should be done, as a scientific community we have the knowledge and the experience to deliver the services that people before and after Julian Falconer’s findings needs.

My hope is that the Ashley Smith’s inquiry will not turn into self-flagellation or into finger pointing, but that it will create the momentum to create a turning point on how to deal with people who we perceive as different. Canada knows what to do, I see the miracle of rehabilitation at work every day, very much as all the other committed workers in the private and the governmental system know. The coroner’s finds just told us that it is time to do it.

Dr. Giorgio Ilacqua

Holidays from Hell?

The holiday season is likely the most stressful and most expensive period of the year for most people. Stress, irritability, hopelessness, despondency or depression at this time of year are common and affect a significantly larger segment of the population than at any other time.

The holidays are also quite expensive, it is not unusual to run the tap into the thousands between, travels, shopping, presents and extra food and drinks.

Holidays should provide a meaningful opportunity for you and for the people you care for, it should not be a source of stress. Family and friends are the natural targets of our love and our most likely source of distress; these people are most likely to be around during the holidays and they are likely to bring their best and their worst to Rossini’s crescendo at a specific time frame and location (generally around a table). Be prepared.

Stress is also brought about by the sense of overeating and feeling bloated; we often asked why do we do this to ourselves when we that too much food is not a good idea for the overworking stomach? Food, especially good food is very tempting, resistance is futile; make the best of it, but try to sneak in good, healthy foods which may feel you up without giving your digestive system extra work. Above all, eat slowly, enjoy it! It is a holiday after all, not another day at the rat-race, no time clock today.

The best strategy to cope with the holiday stress is to be prepared. What it means is simply, that you cannot avoid it, like the weather, just be prepared for it. You know a big wave of stress is coming your way (in the form of obligations and expectations), so make sure that you have some fail-safe or back up plans or if the stress cannot be avoided (like family dinners), bring your own parachute and make the best out of it. Think of it as a change of scenery from the routine of another day at work.

Also plan ahead, so what if you buy the present for your brother in October, he will never know it (unless you tell him) and you have checked out another potential source of stress from your list.

Sleep and rest as much as you can; you are probably eating, travelling, spending and socializing much more than you are used to, so it is natural that you will feel tired and fatigued. Take a nap, it is a good habit throughout the year, do not give up good habits during the holidays or postpone their start to the new-year.

Taking a break from the holidays, although it may appear as an oxymoron, it is often a good idea; you’re on holiday too, you will do all the holidays activities anyways, but do not forget to recharge your batteries, you will be more likely to smile afterwards.

One of the big issues we will encounter during the holiday season is when to say “no.” There are millions of reasons why you should go to another dinner, party or social gathering, or why you should buy more stuff. There are going to be very good reasons why you should do things you do not want to do or see people you do not want to see. Be honest with yourself, at times an honest and polite “no, thank you” is the best strategy for all involved.

Finally, think and concentrate on what makes the holiday special for you (not for others). You are into food, you can hardly wait for the sales, you are going on an exciting trip, you like to spend time with the kids or parents, what do you like about the holidays? Keep focussing on what make the holidays special for you (grandma’s roast, the deals you will be able to score this year) and remind yourself of all the positives waiting for you when you will have to put up with the unavoidable negatives that for sure will come your way; uncle Ben spilled wine on your pants, again! “That’s my uncle, but grandma’s cooking is getting better every year.”

Happy Holidays.

Dr. Giorgio Ilacqua

Nutrition: Good Nutrition equals Good Sleep:

Nutrition plays a role in how we feel. Depending on what you eat, you may find you are more alert when working night shifts and that you can sleep better. Having a meal rich in protein boosts concentrations of chemicals in the brain which can stimulate activity. Eating meals rich in carbohydrates increases concentrations of serotonin, a sleep-inducing chemical in the brain. However, there are other vitamins and minerals that one should know about, especially if you are having difficulty sleeping. The following is a description of vitamins and minerals that can help you sleep:

  1. The B vitamins: These vitamins regulate the body’s use of amino acids, including tryptophan. Some studies have shown that Vitamin B-3, enhances the effect of tryptophan. Tryptophan is one of the 22 amino acids found in protein. Tryptophan is the substance from which the sleep-inducing brain chemical serotonin is made. This vitamin is reported to be effective in alleviating the type of insomnia suffered by people who fall asleep readily but who are unable to fall back asleep after awakening later in the night. The current Recommended Dietary Allowance (RDA) for vitamin B-3, which is found in high-protein foods such as fish, liver, kidney, chicken, peanuts, milk and eggs is 15 milligrams a day. Other research indicates that some sleep problems can arise from a deficiency Infalic acid, which is a member of the Vitamin B family. This can be found in asparagus, broccoli, cauliflower, cabbage, green peas, kidney and lima beans, beets, sweet potatoes, whole-grain cereals and breads, oranges, cantaloupe and organ meats. The RDA is 180 micrograms per day. B vitamins can be easily leached from our body through cigarette smoking, alcohol, birth-control pills and stress.
  2. Calcium: This mineral is a natural relaxant that has a calming effect on the central nervous system. Some studies have shown that even a minor calcium deficiency can cause muscle tension and insomnia. Stress also rapidly depletes our bodies of calcium. Therefore, you should take enough calcium daily. The RDA is 800 milligrams daily. If you are allergic to milk or just do not like it, try supplemental forms of calcium, like mustard greens, dandelion greens, broccoli, spinach and sardines.
  3. Magnesium and potassium: Magnesium (which is found in potatoes, whole-grain bread, milk, meat, fish, poultry, eggs, dark green leafy vegetables and citrus fruits), is a natural sedative. Studies have shown that magnesium deficiency can cause insomnia. The RDA is 280 milligrams a day. Potassium (which is found in meat, milk, potatoes, bananas, oranges, apricots), in combination with magnesium has also been found effective in alleviating chronic fatigue.
  4. Zinc: A deficiency in zinc can contribute to insomnia. This mineral can by found in oysters, herring, meat, milk, eggs, whole grains, peas, beans soybean curd, raisins, dried figs and apricots. The RDA is 12 milligrams per day.
  5. Iron and copper: Recent studies reported that a deficiency in either copper or iron has an effect on sleep patterns. Women who received insufficient amounts of copper or iron, reported that they found themselves sleeping longer than usual and also waking more frequently during the night. They also reported that they would awaken tired and not refreshed. There is no RDA for copper. However, it can be found in whole-grain cereals and breads, shellfish, nuts, organ meats, eggs, poultry, dried beans and peas and leafy dark-green vegetables. The RDA for iron is 15 milligrams a day. It is found in organ meats and dark-green leafy vegetables, as well as in beef, sardines, oysters, prunes and other dried fruits, peas and lima beans.

Dr. Alfonso Marino

Rob Ford; a Mayor’s disappointment

It is all over the media; Rob Ford the Mayor of Toronto the largest city in Canada admitted to having used crack cocaine while drunk.

Stories like this become a bonanza for the media, the political activists and the late night talk shows. The public opinion is divided along partisan and political lines ranging from the ones calling for the Mayor’s resignations and the ones stressing the personal and privacy side of the story; probably most of the general public is simply indifferent or oblivious.

The major disappointment in this story is that we are still missing how serious the drug problem is in this city, in this province and in the country. Now that even the Mayor is admitting to using an illicit substance which is likely to cause many psychological, behavioural, cognitive, familial, community and workplace consequences, why not taking the opportunity to address this problem and stop pretending there is no elephant in the room?

Let’s start by putting the issue of drug abuse into perspective; for how many people is crack cocaine a problem for? Like any other illicit behaviour statistics are underestimating the real size of the problem, but for example from a survey conducted in 2005 in Ontario about 43,000 students from grade 7 to grade 12 used cocaine at least once in the previous year, while about 20,000 have used crack cocaine in the same referenced period. Over one per cent of Canadians 15 years and older used crack or cocaine in 2012, according to Health Canada’s Canadian Alcohol and Drug Use Monitoring Survey.

Crack cocaine is the third most abused illegal drug in Canada, right after marijuana and hallucinogens. Crack cocaine is the most addictive form of cocaine, it builds up tolerance quickly and it is one of the hardest drugs to quit.

The city of Toronto recently described the typical crack cocaine addict as one of alienation, solitude and danger; the wide spread use crack cocaine is of “most concern” in T.O.

And what’s about the true cost of crack cocaine’s addiction? Besides the $ that it takes to maintain the addiction the true cost of crack cocaine is to be expressed in wasted lives (of the addict and of the people around him or her). How can the human cost for the family (likely to experience divorce, financial distress, violence and abuse), the community (likely to experience violence, illegal behaviours and increased risk of motor vehicle accidents) and the workplaces (likely to have increased lost time, inefficiency and accidents) be accounted for? What’s about the children of crack users and what’s about the cost of the violence triggered by crack cocaine? What’s about the family and friend who are trying to help but they cannot because there are not enough facilities to get all the addicts the crack-cocaine addiction treatment and detox that they need?

Simply talking about one person (Mayor or common citizen) will not do anything to help the other thousands trying to control and manage the modern day curse of illegal drugs.

I really hope that Rob Ford will not become a Mayor’s disappointment and that thanks to his admission there will be an increased awareness about the issues that people dealing with drug related problems have to face on a daily basis.

Dr. Giorgio Ilacqua

Circadian Rhythms and Sleep

Insomnia can be manifested by circadian rhythm disorders, such as jet-lag or shiftwork. Insomnia can also contribute to a dynchronization of the circadian rhythm. Physiological and biological activities (body temperature, chemical/hormonal secretion, etc.) may become misalligned or suppressed because the insomniac is awake when he or she should be asleep. When assessing insomnia it is important to assess what effects it may have on the circadian rhythm, or conversely, what effects the circadian rhythm has on insomnia.

Human beings are a rhythmic species, experiencing cycles every 24 hours. These 24 hour cycles are known as circadian rhythms or more commonly known as one’s biological clock. In determining an individual’s circadian rhythm, a particular variable (i.e. body temperature, hormone secretions) must be measured repeatedly at different points of the day. When measured, systematic changes can be noted from one time of the day to another. These changes are consistent during a 24 hour period. For example, when one is asleep and body temperature is taken, it usually goes down during the night and early morning. This cycle repeats over a 24 hour period.

The purpose of this internal clock is to prepare the body and brain for sleep and active wakefulness at different times of the day. Moreover, the biological clock lowers body temperature, heart rate and blood pressure and controls the excretion of hormones like melatonin, which help induce sleep. The biological clock also protects our sleep by suppressing hunger and renal and bowel functions, permitting longer and more consolidated sleep with minimal disruptions. Combined, these factors produce a high quality of sleep.

When the biological clock becomes misalligned, due to jet-lag or shiftwork, sleep onset is difficult. A good sleep is important for it enables individuals to feel refreshed, energetic and vigilant, aiding with daily functioning. The inability to fall asleep at a “normal” time and obtain an adequate amount of sleep, can contribute to physical and psychological health difficulties, as well as negative safety and financial issues.

Dr. Alfonso Marino