Anthony Vertino Coaching Services

07/09/2020

Here is Ben Franklin’s daily schedule written by him at age 20.
He starts his day with gratitude and sets goals to do good. And finishes his day with a review of his good works for the day.

06/22/2020

https://www.youtube.com/watch?v=vrNQbLtr_YE

A brief video on the changes you need to make to manage your focus and attention better and make lasting changes to your neurology. If you'd like to schedule...

03/19/2020

If your sessions are not covered at this time, if your therapist is unavailable due to the virus or social distancing, if your groups have been cancelled or postponed, you can call my office for a free consulation.

03/17/2020

When your media robs you of joy.

We have 6 primary emotions. They exist in all cultures and are hardwired into our brains. They are recognizable, even without the use of a common language. We recognize them by sight and sound. Emotions evolved within us and are necessary for the survival of the individual and the species. Anger, fear, sadness, disgust, surprise and joy are their most familiar names.
Media and marketing cleverly operate on these primary emotions. They activate our threat detection network eliciting anger or fear, play upon our sadness and desire to care for others, present material designed for responses of disgust and loathing, or shock us and surprise us into attention and alertness.
Sometimes, with far less frequency, media will lift our spirits (joy).
Additionally, parts of the brain that are responsible for logical thought, tune out during television viewing. The impact of television viewing on one person’s brain state is obviously not enough to conclude that the same consequences apply to everyone. However, many research studies have repeatedly shown that watching television produces brainwaves in the low Alpha range or the most passive and suggestible range of brain wave activity often observed when subjects are under hypnosis.

I was originally going to write this post based solely on political stress. Now, I find myself realizing its much more than that. It’s the media driven stress related to the corona virus and of course, the politicizing of it. As well as, the cancellation and reduction in the number of activities that we use to feel joy.

So, here’s a brief list of some ideas for keeping perspective in these challenging times.

Limit your media exposure – Or in plain language turn that the thing off.
Kind of obvious, but here’s some of the reasons why it's important.
Media information including medical discussions or political media reports are positioned to put us in a fight or flight response mode. We are often given information in a confrontational way or in a competitive manner such as Right vs. Left, Liberal vs. Conservative. Polarization of topics affects us most directly, because we are given limited parameters to view the issue. Liberals believe X and conservatives believes Y and the two are at odds. The implication is that you should be at odds with the opposition’s views. These are false premises and cognitive distortions of over-generalization and all or nothing thinking. All conservatives think this way and all liberals think this way and they cannot think any other way.
Because of packaging, marketing, and salesmanship of the information, our ability to choose broader, creative, more inclusive reasoning is limited. This is a tactic that plays on fears of scarcity and lack. There aren’t any other options provided so people often go deeper into fight or flight because of lack of solutions and fear of terrible outcomes.
Powerlessness is also a media tactic. Because you cannot solve the issue in the present moment, your frustration levels are likely to increase. And the conclusions are often of a doomsday scenario. This furthers our fight or flight responses because we feel powerless and afraid of the outcomes.
Also, the media gives us their conclusion with the story, so you don’t have to bother with reasoning it out for yourself. Since you’re already in a suggestible pseudo-hypnotized state the resistance to their opinions is significantly limited. You may not always have access to or have the ability switch on your Beta wave, logical mindset.
So, turn the media off. Unplug. Take a break. Get away from it for a while. Let your normal reasoning skills engage. Reboot the system. Whatever phrasing you need to use, use it to disengage. Peace of mind and calmness and clarity of thought matters. You’ll be doing yourself and everyone around you a great service.

Another helpful technique during these times, is to remember the PAUSE.
Pausing, reflecting, reprocessing, and making sure that your body and brain and calmer before you actively engage with the information you’re trying to process, helps limit the fight or flight response.
When you pause, try to think of future solutions and plans not the immediate and present moment emotions tied to an issue. Try not to fall into the media trap of blaming and fault finding, all or none thinking and over-generalization.
Think of how you would vote on an issue what provisions would you need included to vote your conscious clearly and be at peace with your vote.

Lastly, be aware of your own bodily and mental reactions (mindfulness).
Be mindful and remember it is all just information. Some of it is actionable and some of it is not. Some is clear and factual. Some is hyperbolic and incendiary. We need to use our minds filtering mechanisms to their fullest. We need broader perspectives and deeper thought and understanding before we react.
Be aware of your surroundings, including others around you and the general thoughts, approaches, leanings, and demeanors regarding these issues that are media driven and/or political. Misalignments, disconnection, and opposition are a breeding ground for bitterness and unhappiness in your world. Where agreement, connection, harmony, and understanding are the roots of happiness.
While there is always more to say on these topics, I hope you find this post helpful during these trying times. Take care and God bless.

DrV

06/26/2019

https://www.msn.com/en-us/health/health-news/dementia-risk-tied-to-these-commonly-prescribed-drugs-in-a-new-study/ar-AADlGXe?li=BBnba9O

There was nearly a 50% increased odds of dementia among adults aged 55 and older in the UK who took a strong anticholinergic medication daily for at least three years, according to a new study.

06/17/2019

Teens and screentime study.

A new study in the journal Child Development shows nighttime usage of a cell phone can increase anxiety and depression in teenagers and reduce self-esteem. This is the first study that shows a direct link between screen time and mental health. Psychologist and CBS News contributor Lisa Damour joins....

03/22/2019

Some ADHD Meds Tied to a Higher Psychosis Risk Than Others
Amphetamines are associated with a higher psychosis risk than methylphenidate in young patients who take these agents to treat attention deficit hyperactivity disorder (ADHD), new research suggests.
Stimulants are recommended as first-line treatment for ADHD. Although methylphenidate is the most frequently prescribed stimulant in many countries, amphetamines are the most commonly prescribed agents in the United States.
Assessing data on more than 220,000 adolescents and young adults starting on a stimulant for ADHD, investigators found that about 1 in 660 participants experienced new-onset psychosis in the following 4 to 5 months.
Among those patients, the risk for psychosis was almost twice as high with the use of amphetamines than with methylphenidate.
"For prescribers, I think the take-home point is that it's really important to screen for potential risk factors," such as a prior history of bipolar or other psychiatric disorder, a family history of psychiatric illness, or use of cannabis, lead author Lauren V. Moran, MD, assistant professor at Harvard Medical School in Boston and a psychiatrist at McLean Hospital, Belmont, Massachusetts, told Medscape Medical News.
"If patients have those risk factors, I would shy away from using the amphetamines. You don't want to have two things that could potentially further increase the risk for psychosis," she added.
The findings were published in the March 21 issue of the New England Journal of Medicine.
Little Comparative Research
Although the US Food and Drug Administration mandated labelling changes for stimulants in 2007 warning of the possibility of treatment-related psychotic or manic symptoms, current ADHD guidelines note that methylphenidate and amphetamines are the most effective treatments for the condition, "with no specification of preference for one over the other," the investigators write.
"Whether the risk of psychosis in adolescents and young adults with ADHD differs among various stimulants has not been extensively studied," they add.
The researchers note that both drugs cause the release of dopamine and inhibit the dopamine transporter.
"However, dopamine release is four times as high with amphetamine as with methylphenidate, whereas methylphenidate is a more potent inhibitor of dopamine transporters," they write. "The changes in neurotransmission observed in primary psychosis are more consistent with those induced by amphetamine."
Moran noted that there are many college students in the area around McLean Hospital and that in her anecdotal experience as a psychiatrist working in a unit that treats patients with psychotic disorders, she's "been seeing cases of young individuals coming in with psychosis" after stimulant use.
"Although the use of these medications has been rising rapidly, I was personally surprised that there's been no real comparison studies for psychosis risk — especially because there are subtle biological differences," she said.
Amphetamines the Preferred Choice
In the current analysis, the researchers examined patient records from two US insurance claims databases: Optum Clinformatics and IBM MarketScan. They initially assessed 337,919 patients between the ages of 13 and 25 years who were diagnosed with ADHD and who received a first prescription for a stimulant from January 2004 through September 2015.
The final study population comprised 221,846 patients — with half taking methylphenidate or dexmethylphenidate (the "methylphenidate group") and the other half taking amphetamine-dextroamphetamine, dextroamphetamine, or lisdexamfetaimine (the "amphetamine group"). Among the total group, there were 143,286 person-years of follow-up.
Interestingly, 3.8 times as many patients received an amphetamine prescription in 2015 than in 2005, but only 1.6 times as many patients received a methylphenidate prescription during the same time period.
"It's unclear to me what exactly is driving the increased preference of prescribers to start somebody on amphetamine as compared to the Ritalin-type drugs," Moran noted.
In addition, 72.5% of the participants treated by family medicine or internal medicine physicians received an amphetamine prescription, as did 51.6% and 63.7% of those treated by pediatricians and psychiatrists, respectively.
The primary outcome for the study was a new diagnosis of psychosis for which an antipsychotic medication was prescribed during the first 60 days after the date of the onset of psychosis.
Diagnoses that qualified as psychosis included major depressive disorder or bipolar disorder with psychotic features, schizophrenia spectrum disorders, delusional disorder, hallucinations, and unspecified psychosis.
"We weren't really looking at transient symptoms of psychosis that go away after a couple of days. We were looking at more severe cases. A majority of the patients were hospitalized and discharged with a prescription for antipsychotics," Moran said.
To determine hazard ratios (HRs) for psychosis, propensity scores from patients who received methylphenidate were matched to those who received amphetamine in each database. The results were then pooled from both databases.
Psychiatrists More Cautious?
Results showed that 106 episodes of psychosis occurred in the full methylphenidate-receiving group (0.10%) vs 237 episodes that occurred in the full amphetamine-receiving group (0.21%).
The incidence rate of psychosis was 1.78 vs 2.83 episodes per 1000 person-years of drug exposure for each group, respectively. Median time from receipt of first stimulant to psychotic episode was 128 days.
The pooled HR for psychosis across both databases was 1.65 for the amphetamine group vs the methylphenidate group (95% confidence interval, 1.31 - 2.09).
Post hoc analyses showed that patients treated by family medicine/internal medicine physicians and pediatricians had a significantly higher risk for psychosis from use of amphetamine than with methylphenidate (HRs, 1.78 and 1.70, respectively) — but those treated by psychiatrists did not (HR, 1.38).
"However, the post hoc nature of the analyses and the inadequate power limit the interpretation of these findings," the investigators write.
"Patients referred to psychiatrists for ADHD may have cognitive deficits or behavioral features that are related to prodromal psychosis, and data on prodromal symptoms would not be captured in claims data. Psychosis may develop in these patients regardless of stimulant treatment," they add. They also speculate that psychiatrists may be more cautious when prescribing amphetamines and may screen more for psychosis risk factors. Moran noted that although the study wasn't a randomized controlled trial, "it reflects real-person practice. This is real-world evidence."
"Studies show that stimulants for ADHD might be more effective than non-stimulants, so it can be a little tricky. But definitely in someone who's had a psychotic reaction, or someone who has risk factors for psychosis, I'd avoid stimulants altogether," she said.
Debate Continues
"Despite meta-analyses that show the efficacy of stimulants in reducing ADHD symptoms, at least in the short term, the quality of evidence and the safety of these medications continue to be debated," Samuele Cortese, MD, PhD, Center for Innovation in Mental Health, University of Southampton, England, writes in an accompanying editorial.
He adds that there have been little data on the comparative risk for psychosis between methylphenidate and amphetamine.
The current results "are consistent" with a previous meta-analysis of randomized trials that suggested greater safety for methylphenidate, "at least at the group level," Cortese writes. But, he adds, the new findings "should not be considered definitive."
Study limitations cited include its observational nature, which cannot exclude confounding factors as well as a randomized trial would, and that it could not establish causality.
In addition, "whether psychosis is due to stimulant use, to inherent vulnerability to psychosis, or to the interaction of those factors remain unclear," Cortese writes.
"Despite uncertainties regarding causal mechanisms, the study by Moran and colleagues provides important data on the incidence of psychosis observed in routine practice among patients with ADHD," he adds. "These figures could inform decision making among patients, families, and physicians."
Cortese notes that although it isn't yet possible to identify which patients will have an episode of psychosis after being treated with a stimulant, strategies such as machine learning plus observational data may eventually "provide predictors at the individual patient level."
The study was funded by grants from the National Institute of Mental Health. Moran has disclosed no relevant financial relationships. Disclosures for the other study authors are fully listed in the original article.
N Engl J Med. 2019;380:1128-1138 and 1178-1180. Abstract, Editorial

03/20/2019

New study makes strong link between use of potent cannabis and psychosis

A new study published in The Lancet has found how cannabis use affects the incidence of psychosis.

INDIVIDUALS WHO USE cannabis every day are three times more likely to suffer from a psychotic disorder than those who don’t use the drug at all, a new study has revealed.

The study, which examines how cannabis use and strength affects the incidence of psychosis, found that the odds of having the disorder among daily users of the drug were 3.2 times higher than among non-users.

It also found that users of high-potency cannabis were approximately 1.6 times more likely to have a psychotic disorder than those who never used the drug.

The study, published today in The Lancet Psychiatry journal, claims to be the first to show the impact of cannabis use on population rates of psychosis, and highlights the potential public health impact of changes to the legal classification of cannabis.

To carry out the study, researchers compared more than 2,000 people between the ages of 18 and 64 at 11 sites in Europe and one in Brazil between 2010 and 2015, in order to understand the risk factors associated with the disorder.

Of these, 901 patients had presented to mental health services following their first episode of psychosis, while a further 1,237 were studied as “healthy matched controls”.

Comparing the two groups, researchers collected information about participants’ history of the use of cannabis and other recreational drugs.

They used published data on levels of delta-6-tetrahydrocannabinol (THC) – the psychoactive compound in cannabis – to evaluate the potency of cannabis used by participants.

They also separated cannabis used by participants into two categories: cannabis classed as high potency, where its THC content was over 10%, and cannabis classified as low potency (under 10%).

No longer available

The research found that daily cannabis use was more common among patients who had their first episode of psychosis (266 of 901 participants), compared to the “healthy” control group (84 of 1,237 participants).

Meanwhile, high-potency cannabis usage was more likely among patients who had their first episode of psychosis (334 of 901 participants) than those in the “healthy” control group (240 out of 1,237 participants).

The study also discovered that psychosis was five times more likely among those who used high-potency cannabis on a daily basis, and estimated that one in five new cases of psychosis across the 12 sites in the study were linked to daily cannabis use.

In two sites, Amsterdam and London, high potency cannabis was found to be a strong predictor of psychotic disorders.

In Amsterdam, four in 10 (43.8%) new cases of psychosis were estimated to be linked to daily cannabis use, and five in 10 (50.3%) new cases were linked to high potency use.

Meanwhile, rates of psychosis in London were 21% among daily users, and 30.3% among those who used the drug with high rates of THC.

The researchers suggested that if high potency cannabis was no longer available, the incidence of psychosis in Amsterdam would be expected to halve from 37.9 to 18.8 per 100,000 people per year, while in London, it would fall from 45.7 to 31.9 per 100,000 people per year.

At-risk individuals

Dr Marta Di Forti of King’s College London, the lead author of the study, claimed the findings were consistent with other studies linking high cannabis potency with adverse effects on mental health.

“As the legal status of cannabis changes in many countries and states, and as we consider the medicinal properties of some types of cannabis, it is of vital public health importance that we also consider the potential adverse effects that are associated with daily cannabis use, especially high potency varieties,” she said.

The research follows observational studies which have supported a causal link between cannabis use and psychosis, although none has previously shown that patterns of cannabis use can influence rates of psychosis on a national level.

Commenting on the findings, Dr Suzanne H Gage of the University of Liverpool suggested that the findings indicated that a new approach to treating psychosis among cannabis users was required.

“Given the changing legal status of cannabis across the world, and the associated potential for an increase in use, the next priority is to identify which individuals are at risk from daily potent cannabis use, and to develop educational strategies and interventions to mitigate this,” she said.

People Before Profit TD Gino Kenny suggested that regulating cannabis for recreational use would allow Irish users to consume the drug more carefully.

Kenny’s Cannabis for Medicinal Use Regulation Bill is currently moving through the Dáil, although the government delayed the Bill with a money message last year.

“We need to have a grown-up conversation about this,” he told TheJournal.ie.

“There are forms of unregulated street cannabis that have very high forms of THC, which can be sold by people who are sometimes unscrupulous.

“Regulation would take it out of their hands and allow users to make a choice about the strength of cannabis they use, even if it wouldn’t stop varieties with high levels of THC.”

He added that the findings did not affect his call for the legalisation of cannabis for medicinal use, which contains low levels of THC.

03/15/2019

Inactive Ingredients in Medications Cause Trouble for Some
Troy Brown, RN
March 14, 2019
Most approved medications have inactive ingredients that could cause problems for individuals with allergies or intolerances to those ingredients, researchers say. Those problems can add up when patients take more than one medication with troublesome ingredients.
"For most patients, it doesn't matter if there's a little bit of lactose, a little bit of fructose, or some starch in there. However, there is a subpopulation of patients, currently of unknown size, that will be extremely sensitive to those and develop symptoms triggered by the inactive ingredients," Daniel Reker, PhD, a Swiss National Science Foundation postdoc at Massachusetts Institute of Technology's (MIT) Koch Institute for Integrative Cancer Research in Cambridge, Massachusetts, and a lead author on the study, said in an MIT news release.
Drugs typically contain the actual drug, or active pharmaceutical ingredient (API), and inactive ingredients (excipients). Inactive ingredients "are not intended or expected to have a direct biological or therapeutic effect but instead are added to alter the physical properties of an oral solid dosage form (tablet or capsule) to facilitate absorption; to improve stability, taste, and appearance; or to render the therapeutic tamper resistant," the researchers explain.
However, increasing numbers of clinical reports describe allergic reactions to excipients such as lactose and chemical dyes, write Reker and colleagues. They published their findings online March 13 in Science Translational Medicine.
In addition, the authors suggest that intolerance to inactive ingredients, such as gastrointestinal disturbances, are likely underestimated. Patients older than 65 years, almost one third of whom take five or more pills each day, are particularly vulnerable.
Although established excipients have demonstrated "safety on the population level and, can be reviewed to evaluate their toxicities, health effects that are undetectable in current preclinical toxicology screenings could remain obscured," the authors write.
To learn more about the unwanted effects of excipients, the researchers conducted a comprehensive analysis of 18 of the most commonly prescribed active ingredients (54 unique medications). They used the National Library of Medicine's Pillbox database, DailyMed, and the web resources of the manufacturers to learn more about inactive ingredients in prescription and nonprescription drugs.
Of 38 commonly used excipients that are known to cause allergic reactions, lactose was used in 44.82% of all solid oral dosage forms in the databases searched, followed by corn starch (36.54%), polyethylene glycol (36.03%), povidone (35.8%), and carboxymethylcellulose (21.38%). Other oral medications include peanut oil, wheat starch, artificial dyes, and certain sweeteners.
For most medications, the amount of inactive ingredients accounted for half of the pill and for some that amount reached 99%.
Most (92.8%) of oral solid medications in the databases contained one or more potential allergen and almost all contained compounds that some patients would be unable to tolerate, such as gluten and some sugars.
"For example, the symptoms of irritable bowel syndrome (IBS) are being increasingly managed in part by a diet that is low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs). Fifty-five percent of all oral medications contained at least one FODMAP sugar in their formulation, and 5% contained more than one FODMAP sugar," the researchers write.
Many medications are available in multiple formulations and the list of inactive ingredients can be difficult to understand and imprecise. For example, gluten may not be listed as gluten or the product information may not specify the amount in the medication, according to an MIT news release. Other ingredients or categories of ingredients that can be derived from wheat include wheat flour, wheat starch, ingredients derived from starch, ingredients produced by fermentation, and wheat germ oil, according to the US Food and Drug Administration, which has recently recommended including gluten content to labels.
The researchers say in one survey they found, 18% of manufacturers reported their medications contain gluten. However, of the 69% that claimed they had gluten-free products, only 17% had actually tested their products and had documentation of these tests.
It can be difficult to find a formulation without the offending expedient. "Viewed through the lens of the APIs, only 28% of active ingredients have at least one available formulation that avoids all of these potential allergens, and only 12% of APIs are free of inactive ingredients that have been reported to cause allergic reactions," the authors explain.
"In many cases, particular APIs will contain a specific [adverse reaction–
associated inactive ingredient (ARAII) ] in all available formulations. For example, all available rosuvastatin calcium and diclofenac tablets, among others, contain lactose as an inactive ingredient which might cause allergic reactions through contamination with milk protein," they continue.
Inactive ingredients can account for more than half of a medication's mass, and sometimes much more. Some patients may have a severe reaction such as anaphylaxis, whereas others may experience adverse effects that are less severe but still bothersome, such as abdominal pain or bloating. These effects can intensify for patients who take multiple drugs or doses with ingredients to which they are sensitive.
The investigators are conducting a follow-up study among healthcare providers to examine how widespread this issue is, and they hope to further study the extent to which commonly used inactive ingredients cause symptoms in patients with intolerances.
"Recognizing that the inactive portion of a medication, which corresponds on average to two-thirds of the administered material, may be more 'active' than previously anticipated, we foresee potential implications for medical protocols, regulatory sciences, and pharmaceutical development of oral medications," the authors conclude.
Reker and two coauthors are co-inventors on a provisional patent application encompassing systems and algorithms capable of quantifying and providing inactive ingredient burden in medications. One study author reports consulting relationships with Avaxia Biologics, Novo Nordisk, Egalet, Janssen, and Merck and holds equity in Lyndra and Vivtex. Complete details of all relationships for profit and not-for-profit for this author can be found here. One study author reports a consulting relationship with Two River Consulting and is an equity holder in Kronos Bio Inc.
Sci Transl Med. Published online March 13, 2019. Abstract