What do you wish to understand further about Psychiatry in the Mainstream?

Here’s a poll : The top most voted choice will become the next topic of my blog. The options are:
1) What is Adult Attention Deficit Hyperactivity Disorder?
2) How does psychotherapy or “talk therapy” help people resolve their lifelong psychological issues?
3) How do psychotropic medications help people with mental health problems?
4) Why did Katy Perry marry a sex addict?
Please make your selection from the options above by leaving a comment. I look forward to your interest, particularly so that I could help improve the understanding of psychiatry per your curiosity. 
Dr. Psych Mainstream


Filed under Celebrities

Bereavement, Grief, and Mourning

Steve Jobs 1955-2011

Steve Jobs, one of the most influential visionaries of our day, recently died. His untimely death not only left a void in Silicon Valley and an uncertainty in tomorrow’s society, but it also created an immense blanket of sadness over the world.

When someone leaves us in this world, sadness most often ensues. If not sadness or depression, death also triggers denial, anger, bargaining, or acceptance. What was your initial reaction when you found out Jobs died? What about your reaction now? Moreover, how did you react when you found out that a personal loved one was dying or suddenly passed away?

Bereavement and grief are terms used to describe aspects related to the matters of death. Bereavement refers to the state or the fact of the loss of someone to death. Grief, on the other hand, refers to the reactive process to the death which includes emotional, mental, and behavioral reactions.  A bereaved individual has experienced the death of someone, but will not necessarily be grieving, but a person in grief is inherently in bereavement. Grief also broadly describes the response to other types of loss, such as to the loss of youth, opportunities, and abilities. Think of Sharon Stone who now has to play second fiddle to a younger more beautiful actress or Peyton Manning who cannot quarterback this season due to injury (I wonder who’s grieving more – Manning or Colts fans?).

Mourning, another term associated with death, describes more specifically the behavioral manifestations of grief.  Mourning is a grieving process that is influenced by social and cultural rituals, including traditions like funerals, visitations, and other customary practices.

In psychiatry, treatment is not typically warranted unless grief becomes “complicated grief” or  the sadness worsens into a major depressive episode. Complicated grief, as opposed to normal uncomplicated grief, is prolonged and severe to the degree that causes significant impairment in work, health, and social functioning. Therapy and medications are standard treatments, with emphasis on coming to terms with the loss and working towards repairment.

Death is a natural part of life. As painful and unfair it feels to have lost a loved one, death and grief have their reason and purpose. If not, then it would certainly be difficult to comprehend why Jobs prematurely left us before we felt it was time.

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Bipolar Disorder

Britney Spears

Bipolar affective disorder (BAD) is a lifelong psychiatric illness characterized by severe and extreme mood instability. Also referred to as manic depression, people with bipolar fluctuate between periods of intense high and low moods like baseball fans following their beloved team deep into the October playoffs (Go GIANTS!!!). Many mainstream films have portrayed characters suffering from BAD – Mad Love, Bulworth, Running With Scissors, and King of California. Numerous famous folks have also been associated with the illness, including Beethoven, Edgar Allen Poe, Vincent van Gogh, and Britney Spears.

As its name suggests, people with bipolar vacillate between poles of euphoria, irritability, and depression, like a perpetually swinging pendulum. The mood episodes are sustained, autonomous, and occur independently of external circumstances and are not caused by substance use. For example, a person who flies high on cloud nine by winning the lottery, falls despondent after carelessly losing the winning ticket, and then becomes enraged when intoxicated at the bar is not bipolar. Moreover, people who experience severe mood instability that is triggered by interpersonal relationship difficulties are often misdiagnosed with BAD, but instead may suffer from borderline personality disorder (BPD).

The expansive or abnormally irritable moods are referred to as mania or hypomania, with the former being more intense and severe.  A manic episode lasts for at least one week and is accompanied with symptoms such as decreased need for sleep, grandiosity, hypertalkativeness, racing thoughts, increased goal-directed behavior, and impulsivity in pleasurable activities like spending money and sexual indiscretion. Psychosis may even ensue. Feeling energetically on top of the world, manics may generate many creative and innovative ideas. Our world would definitely not be as advanced and inspiring as it is today without the actors, entrepreneurs, mathematicians, musicians, and writers who lived with bipolar disorder.

Mania becomes concerning and problematic when people begin to lose their insight and judgment, making ill-advised decisions and engaging in destructive behavior – remember Britney Spears shaving her head completely bald and attacking an SUV with an umbrella? Social and occupational functioning may be profoundly impaired, necessitating involuntary inpatient hospitalization and mood-stabilizing medications.

Depressive episodes are more psychologically distressing to the individual than manic ones. Would you rather be anhedonic and socially withdrawn or elated and running around Nordstrom maxing out your credit cards?  Depression occurs 3 times as often than mania and raises the risk of suicide. Up to 50 percent of people with BAD attempt suicide, and 15 percent die from completing it.  Kurt Cobain, who was suspected of suffering from bipolar depression, sadly ended his life with a self-inflicted gunshot wound to the head.

BAD is a chronic illness which causes episodic and persistent functional debilitation. Psychiatric treatment is necessary to stabilize mood and maintain day-to-day functioning. Referred to as an illness that “benefits mankind at the expense of the individual,” I wonder if the aforementioned famous manic depressives were aware of their generosity in bestowing upon us The Fifth Symphony, The Tell-Tale Heart, and Starry Night, respectively. And I certainly cannot forget to include Oops!…I Did it Again.

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Filed under Celebrities, Diagnosis, Film

Codeine Syrup

Jamarcus Russell with the Oakland Raiders (2007-2010)

Jamarcus Russell, the former NFL quarterback and exorbitantly paid #1 overall draft pick in 2007, was arrested last week for unlawful possession of codeine syrup without a prescription during an undercover sting. He was suspected of illegally abusing the controlled prescription cough medication for recreational use as Purple Drank.

Purple Drank (aka Syrup, Sizzurp, Drank) is an increasingly popular party drink found in the South. It’s a liquid concoction typically consisting of codeine syrup, promethazine (antihistamine), clear soda, and Jolly Ranchers. It conjures up similarities to the super-sweet mystery “jungle juice” often found at college frat parties (which on the otherhand is legal unless underage drinking is involved).  The codeine-based mixture was born out of the underground rap scene in Houston in the 60’s.  It gained popularity in the early 90’s when hip hop music artist DJ Screw credited the drink as the source of his inspiration for creating the “chopped and screwed” remixing style. The music is characterized by the slowing down of the tempo of rap music, just as how codeine slows down brain activity. The drink’s popularity further spread from Texas to other parts of the South and later entered into the mainstream’s awareness when Three 6 Mafia released its hit single “Sippin’ On Some Syrup” in 2000. Now, Russell is almost rendering Purple Drank as much of a household term as The Office’s “That’s what she said!”

Codeine is an opioid, like morphine and heroin. The drug is abused for the euphoric high and rush that it gives people. Clinically, codeine is used as a painkiller, as in Tyelnol #3, and a cough suppressant, as opioids suppress the cough reflex. Although codeine is 1/10 as potent as morphine and way less toxic than heroin, it nevertheless carries all the potential negative effects of opioid misuse – intoxication with speech slurring and cognitive impairment, addiction, and death by coma and respiratory depression.  The effects of opioids are further intensified by alcohol, an often deadly combo of CNS depressants. You can probably guess what caused DJ Screw’s premature death.

Stopping or reducing heavy and prolonged opioid use will lead to withdrawals.  Although opioid withdrawal is rarely ever life-threatening, it causes very distressing symptoms like irritability and dysphoria, piloerection (fancy way of saying goosebumps), nausea, diarrhea, muscle cramps, aches, and flu-like symptoms.  It’s definitely not what you want to be going through on a first date. Interestingly, the common expressions used to describe the abrupt cessation of habitual behavior – go cold turkey and kick the habit – come from the opioid withdrawal symptoms of goosebumps (resembling a plucked turkey) and muscle spasms in the leg (causing kicking movements), respectively.

Prior to his recent legal troubles, Russell’s life on the field was no better. Two months earlier, the Raiders severed ties with him and released him to unrestricted free agency.  Currently, no NFL team would even consider touching him with a 10-foot pole. He’s arguably the biggest draft bust in NFL history. Notorious for his poor work ethic and bad decision making, he also had significant weight gain issues that seems to strengthen the case that he’s been sipping the syrup for some time (the sugar in soda and hard candy coupled with antihistamines will certainly make you a great candidate to compete on the Biggest Loser).  If codeine is truly behind his on-field failure, it would be wise for the once highly-touted natural athlete to seek professional help for his substance use. Maybe then, he could resurrect his career and possibly lead his team to winning a championship title (and then thank his psychiatrist on national TV as Ron Artest did).

If you’re interested in psych issues and sports, you should check out the Sports Psychiatrist, a dear friend and colleague of mine.


Filed under Celebrities, Drugs

Obsessive Compulsive Disorder

The OCD Project (2010)

Summer television has arrived and with it comes the barrage of new and returning unscripted reality programs. 57 and 65, respectively, to be precise. One can probably identify numerous implicit psych issues embedded in some of the reality shows, and likely more so in their cast members.  I don’t watch Jersey Shore, Bridezillas, or Toddlers and Tiaras, but I’m sure that the DSM-IV applies to some individuals on those shows as much as an instruction manual titled “How to Clean Up an Oil Spill” to BP.

Obsessive Compulsive Disorder (OCD) is the focus of the new voyeuristic reality series The OCD Project.  It airs on VH1 and follows a group of six strangers diagnosed with quite severe OCD, who are forced to live together under one roof to receive intensive exposure therapy treatment.  It’s Intervention meets Fear Factor.  Dr. David Tolin, a PhD clinical psychologist who specializes in anxiety disorders, plays the host and head therapist on the show.

OCD is an anxiety disorder characterized by intrusive thoughts and repetitive behaviors. Obsessions are persistent anxiety-provoking thoughts that invade one’s conscious awareness; they are distressingly difficult to ignore like seeing a pregnant woman drinking a 40 and smoking a pack of Marlboros. Obsessions commonly have a fearful theme that either neglecting to do something or making a mistake will lead to some sort of catastrophe.  For example, “If  I don’t check if the front door is locked 6 times before I leave the house, then I’ll get into a car accident today.” Other types of obsessions may center on a fear of contamination, a need for exactness or symmetry, irrational saving and hoarding, or unpleasant aggressive impulses and sexual imagery.

Compulsions are repetitive behaviors performed intentionally to neutralize or alleviate the anxiety resulting from the obsessions. These rituals may range from subtle mental acts like counting or repeating numbers to more obvious physical acts like excessive hand-washing, checking, or rearranging objects. Compulsive behaviors consume time and interfere with routine activities, often to the point of severe functional debilitation. Imagine if the Iron Chef had OCD relating to a fear of contamination and had to wash his hands every time he felt germs defiled them. What type of cuisine, if any, would be prepared then?

Interestingly, many famous and successful celebrities live with OCD. Billy Bob Thorton reportedly obsesses about repetition, Cameron Diaz doorknobs, Howie Mandel germs, and David Beckham symmetry and evenness. In his role as Howard Hughes (who also suffered from OCD) in The Aviator, Leonardo DiCaprio channeled his childhood obsessions with sidewalks to devotedly play the part more effectively.

Reality shows can be repulsively annoying or entertaining and amusing to watch. The OCD Project is definitely more of the latter. It raises awareness of OCD to the mainstream and helps destigmatize mental illnesses, of which I’m definitely a proponent. Nevertheless, I can’t help but feel that it does so at the expense of exploiting and tormenting its cast members in its attempt to cure them of their disorders. Although the VH1 network executives are probably concerned primarily about the show’s numbers and lucrativeness, I hope that patient care is the foremost interest for Dr. Tolin.


Filed under Celebrities, Diagnosis, Television



It’s April 20th.

For the marijuana smoking counter culture, today is known as 420, pronounced four-twenty – National Weed Day. Many marijuana (MJ) users celebrate by convening  across the nation to light up a joint, smoke a bowl, or eat some pot brownies. Unlike Halloween, in which you probably wouldn’t find anyone in costume on the other 364 days, MJ use is ubiquitous and ever-present in the mainstream.  Whether you’re watching TV or listening to music on the radio, attending a sporting event or concert, you’re as likely to be exposed to something MJ-related (like Weeds, Bob Marley, or the downwind smell of pot) as you are to something Kate Gosselin-related at a supermarket checkout line.

MJ is the most prevalently used illicit substance in the world. It is often referred to as the “gateway” drug as once naive recreational drug users may later progress to experimenting with harder drugs such as dropping ecstasy, snorting a line of cocaine, or smoking crystal meth. MJ has more aliases than the National Hockey League has fans. In the medical profession, MJ is frequently referred to as Cannabis, the Greek name of the plant, and THC, its main active ingredient.

Many consider MJ use to be harmless, positive, and even beneficial. Recreationally, MJ is associated with facilitating philosophical thinking, enhancing creativity, and heightening subjective experiences. How many moviegoers do you think were high when they munched on popcorn as they trancedly watched Avatar in 3-D? Medically, MJ has been legalized in 14 US states for treatment of chronic conditions such as glaucoma, pain disorders, chemotherapy-induced nausea and vomiting, HIV unintentional weight loss, and some neurological disorders.

Legalized for medicinal use only in a minority of states, MJ is criminal and illegal on the federal level. As such, the federal governing agency of prescription meds, the FDA, strictly regulates MJ among the highest of controlled substances. MJ is classified as a substance with high abuse potential, no current accepted medical use, and a lack of accepted safety for use under medical supervision. You may get a marijuana card, but you’re absolutely not gonna get a prescription for MJ says Uncle Sam.

The medical marijuana debate remains controversial in the medical profession. Although MJ has been shown to improve the aforementioned medical conditions, it nevertheless has adverse effects on the lungs, heart, and immune and reproductive systems. Moreover, it has the potential to cause cancer.  

In psychiatry, the position on MJ use errs on the side of restriction. Aside from addiction, MJ has been associated with increasing the risk of common psychiatric disorders like anxiety, bipolar, and psychosis. Chronic heavy users of “the chronic” may also experience a generalized lack of interest, decreased motivation, and impaired cognitive functioning. You may want to stay off the grass if you’re gunning to be the school valedictorian. Many MJ users may go through their entire lives without any significant functional impairment, experiencing at worst a “bad trip” from time to time. But what if that bad trip was lasting and permanent like schizophrenia? Is that a journey worth embarking on?

The origin of 420  in reference to weed has as many postulations as that of Tupac’s death. Some think 420 refers to the number of chemicals found in MJ, the police code for MJ use, or Adolf Hitler’s birthday. The leading belief seems to credit a group of pot-smoking teenagers who met up daily to get high after school at 4:20pm back in the early 70s. Whatever the reason, as far as I’m concerned, 420 can mean the number of arguments you can make for or against the use of MJ.

Since I’m a psychiatrist, you can probably surmise where I stand on the issue of marijuana use.


Filed under Drugs

Antisocial Personality

Criminal Minds (2005-2010)

Hands-down the most disturbing of personality disorders is Antisocial Personality Disorder (ASPD). Many mainstream TV dramas base the content of their shows on people with ASPD – Criminal Minds, Bones, Law and Order, The CSI Series, and the list goes on….

In psychiatry, the meaning of antisocial is not the same as the layman’s term used often to describe the shy and sort of awkwardly charming introvert who embarrasses easily. Think Micheal Cera in Superbad or Juno, or any of his other roles. Instead, antisocial refers to people who are sociopaths or psychopaths. They lack a moral compass and have utter disregard for social norms. These people are entitled, deceitful, and remorseless of any type of wrongdoing. They lie, con, and cheat – not the type of person you’d want to meet on Match.com! Their inability, or refusal, to abide by rules and laws may give rise to criminal behavior and consequently overcrowded prisons – more than 80% of inmates are ASPDs. Unlawful acts can vary widely from vandalism, petty theft, and identity fraud to arson, rape, and killing sprees. They can be an acquaintance, co-worker, or even a friend or relative. Not all ASPDs are violent criminals, but Ted Bundy, Jeffrey Dahmer, and Charles Manson  have been described as some of  the most notorious and infamous ones.

Currently in psychiatry, per our bible the DSM-IV, there isn’t a distinction between a sociopath and a psychopath (pending revision). Although they’re both diagnosed as ASPD, and occasionally used interchangeably,  some experts believe they are separate entities.  A key difference between a sociopath versus a psychopath seems to be related to the underlying cause of their behavior, which summons the nature versus nurture argument.  Sociopaths are thought to have been shaped by an invalidating and traumatic upbringing, whereas psychopaths are born emotionally and morally deficient. The latter is hard-wired differently from the get-go. Thus, fearlessness and stimulation-seeking are seen at an early age. Imaging studies have shown brain abnormalities implicated in emotional detachment and physiologic responses characteristic of psychopathic behavior.

ASPDs tend to possess superficial charm and allure, which serves them well in manipulating others for personal gain. Their bodies may be covered with ostentatious tattoos. This is, of course,  not an absolute sign of an ASPD; otherwise, I can’t imagine what it’d be like to be NBA Commish David Stern, given the growing prevalence of tattooed bodies in the league. Also of note, a juvenile history consisting of the triad of bedwetting, fire-setting, and animal cruelty seems to be a harbinger of violent criminal behavior.

Clinically, ASPDs don’t seek treatment for their symptoms per se as they don’t see anything wrong with their antisocial behavior. They typically present for psychiatric treatment in the context of prescription drug-seeking, substance abuse problems, malingering – feigning an illness to get something they want – and violent behavior. Unfortunately, there is no demonstrated effective mental health intervention for treating ASPD itself. Thus, the criminal justice system becomes their de facto treatment system. Somewhat reassuringly, it has been observed that antisocial behavior in ASPDs attenuates over time, particularly beginning in their late 30s.

Many TV watchers become enthralled by crime drama shows like an unsuspecting victim is drawn to an antisocial’s charm and deceit. Entertaining and seemingly preposterous as the shows may be, the reality is that people with antisocial personality disorder do exist and live amongst us. The next time you feel captivated by someone’s charisma, yet feel like you’re being manipulated, follow your gut instinct and change the channel.


Filed under Personality Disorder, Television