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Blog – Janet Settle, MD
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Solvent-induced Bipolar Disorder

By Janet Settle MD

In this post, I’m reporting on the journal article by Adrienne Sprouse MD, et al. Organic Solvent-induced Bipolar Disorder: A Case Report. Advances in Mind/Body Medicine. 2013;27(3):19-23.

Summary: This is the first literature report of new onset type 1 bipolar disorder linked to industrial solvent exposure. This 43 year-old man with a three year history of bipolar disorder, type 1, presented with memory complaints, severe insomnia and auditory hallucinations. On exam: depressed mood and affect, religious delusions, irritability, auditory hallucinations, grandiosity. He was monosyllabic with severely delayed speech so his wife and mother were the primary historians. His symptoms worsened through the week and improved on weekends and vacations. He had no personal or family history of psychiatric illness and had previously been high functioning and productive. His occupation was textile printing using petroleum based dyes and organic solvents. He owned and managed his own printing plant. Meds at intake: lithium carbonate 1650 mg, clonazepam 0.75 mg, Benedryl 25 mg, armour thyroid 90 mg, melatonin 2.5 mg, DHEA 25 mg.

Microbiome-Gut-Brain Axis: Mounting Evidence in Psychiatry

In the Psychiatry MasterClass training programs, we teach the importance of the Gut-Brain Axis. In the literature, the emerging term is the Microbiome-Gut-Brain axis. The microbiome is a 4.4 pound organ in the body whose known functions are growing logarithmically. While we are beginning to appreciate the clinically importance of the microbiome, we are still waiting for direction about which probiotics in what doses. Nonetheless, I do recommend probiotics for my patients. I agree with the wisdom on the street that it makes sense to rotate organisms (i.e. finish one or two bottles of this and then one or two bottles of that, etc.). In this product category, it makes good sense to use professional brands. In a healthy person without a big antibiotic history who has a good diet, consumption of organic raw vegetables (probiotics live inside!) and fermented foods (found in nearly all indigenous diets) may be sufficient. However, our patients working through psychiatric syndromes, including Major Depressive Disorder (MDD), dont fall into that group. I recommend maintenance probiotics for patients who are working on ongoing symptoms or maintaining a remission. I dose those with symptoms of inflammation, pre-autoimmunesymptoms, irritable bowel syndrome, and metabolic syndrome at about 50 billion cfu per day. Otherwise, maintenance dosing is about 25 cfu daily. For those with autoimmune disorders or inflammatory bowel disease, dosing should be more aggressive (100 cfu daily or more). Here are five recent studies that illustrate recent advances.

Physician Burnout: 22.5% of Physicians Considering Leaving Medicine

By Janet Settle MD

In a cross-sectional study of physicians from all specialties (Dyrbye, 2013), the levels of burnout, professional and personal satisfaction were measured in early (practicing 10 years or less), mid (practicing 11-20 years), and late (21 + years) career stages. Burnout, measured using the Hamburg Burnout Inventory, is characterized by exhaustion (mental and physical), detachment and/or depersonalization, and reduced personal accomplishment. A whopping 22.5% of the physicians in this study reported that they were considering leaving medicine in the next 24 months for reasons other than retirement!

Yoga for Perinatal Depression and Anxiety

By Janet Settle MD

In this post, I report on recent evidence for the use of yoga for the treatment of perinatal depression and anxiety.

The term yoga includes a broad and ever growing collection of physical, mental and spiritual practices strictly or loosely based on ancient Indian philosophy. The heterogeneity of these practices make interpretation of health benefits difficult.

Why All Psychiatrists Should Practice Integrative Medicine

By Janet Settle MD

Ive been studying and applying integrative medicine in my psychiatric practice for 20 years. In the early days, I felt a little sheepish introducing myself to teachers and fellow students as a psychiatrist. I went to training after training never meeting another psychiatrist. There were no dedicated courses intended for psychiatrists. In my fellowship program, the 24-hour course on neurology and psychiatry didnt even have a psychiatrist on the faculty. Now, that’s changing and I see more and more psychiatrists and mental health practitioners actively engaged in the world of integrative medicine.