Perusing Psychology

A 2008 study found that Argentina has 145 psychologists per 100,000 citizens. That is the highest rate in the world. The Wall Street Journal reports the following numbers (from 2005 – the number of psychologists in Argentina has increased since that time):

I recently interacted with a person who is depressed (I’ve had a lot of exposure to people with depression over the years but I want to write about one in particular). This person was a pleasant person but a bit dysthymic in general; this person came across as somewhat down and depressed. Recently he started taking bupropion (Wellbutrin) for depression. It’s made a world of difference. Now he appears euthymic and quite animated – it’s a good change. I know that anti-depressant medications are not effective for everyone (and I am fairly critical of psychotropic medications in general and don’t think any should be taken lightly) but in this case, the improvement was marked. It was like night and day. Wellbutrin, incidentally, is also an effective medication for helping people stop smoking (trademark name of Zyban). I have no affiliation with GlaxoSmithKline, who makes the drug (it’s also available as a generic), I just recently witnessed its effectiveness.

Here’s the American Psychological Association press release about the recently passed mental health parity law in the U.S. This is great news for insured people suffering from mental health disorders as well as for psychologists who will now be able to receive better reimbursement for services provided. Here’s a NYTimes article on the bill.

WASHINGTON—President Bush signed mental health parity into law today, taking a great step forward in the decade-plus fight to end insurance discrimination against those seeking treatment for mental health and substance use disorders. This historic legislation requires that health insurance equally cover both mental and physical health.

Congress passed the legislation as part of a new bill that also includes tax extenders, changes to FDIC and the controversial financial rescue plan. The House passed the legislation today by a vote of 263-171. On October 1, the measure passed the Senate by a vote of 74-25.

“With passage of this bill, insurance companies can no longer arbitrarily limit the number of hospital days or outpatient treatment sessions, or assign higher copayments or deductibles for those in need of psychological services,” said Dr. Katherine Nordal, the American Psychological Association’s (APA) executive director for professional practice.

For over a decade, the APA has worked with Congress to achieve a full mental health parity law ending discrimination in health insurance coverage against those suffering from mental health disorders.

The 2008 bill closes several of the loopholes left by the 1996 Mental Health Parity Act and extends equal coverage to all aspects of health insurance plans. It preserves existing state parity and consumer protection laws while extending protection of mental health services to 82 million Americans not protected by state laws. The bill also ensures mental health coverage for both in-network and out-of-network services.

According to the National Institute of Mental Health, more than 57 million Americans suffer from a mental health disorder. According to a 2008 nationwide survey by Harris Interactive in conjunction with the APA, 25 percent of Americans do not have adequate access to mental health services and 44 percent either do not have mental health coverage or are not sure if they do.

Additionally, a 2006 survey from the Substance Abuse and Mental Health Agency reports that 49 percent of U.S. adults with both serious psychological distress and a substance use disorder go without treatment.

“Research shows that physical health is directly connected to emotional health and millions of Americans know that suffering from a mental health disorder can be as frightening and debilitating as any major physical health disorder,” said Dr. Nordal. “It’s our hope that passage of this bill will force our health care system to finally start treating the whole person, both mind and body.”

The American Psychological Association (APA), in Washington, DC, is the largest scientific and professional organization representing psychology in the United States and is the world’s largest association of psychologists. APA’s membership includes more than 148,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting human welfare.

When writing or talking about medical patients or therapy clients, it is helpful to describe their presentation. You cover things such as appearance and grooming, mood, openness, language, and thought process. How a client looks can reveal a lot about their lives, stressors, and their overall cognitive functioning. How open they are with you as a doctor or therapist is also important to note. Sometimes people are reticent to talk about themselves (which is very understandable) and very distrustful in general. Some people also don’t know how to talk about themselves, so they don’t.

The language people use also reveals their underlying cognitive functioning. Tangential language, disjointed speech, and slowed speech, for example can mean different things – a thought disorder, depression, acquired brain injury, and so forth. Related to language is a person’s thought process; this is apparent from their language but also in how they describe their problems or their lives.

When discussing mood, there are three general terms doctors use. The first is euphoric – extremely happy. Sometimes it is appropriate for people to exhibit this emotion but it can also be a sign of mania, especially if the positive mood was not seemingly triggered by anything. The next term for a mood state is euthymic, meaning normal, slightly positive mood. This is the mood that most people exhibit most of the time. It is neither positive nor negative (again, with a slight positive lean). The last descriptor for mood is dysthymic, which means depressed or having negative affect.