@StevenChanMD
STEVEN CHAN, MD MBA
DEMYSTIFYING INVISIBLE WOUNDS
IMAGE: https://www.flickr.com/photos/seeminglee/2249001825 BOKEH iMAGE: https://www.flickr.com/photos/stignygaard/5192721433
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@StevenChanMD
IMAGE: : http://www.dentaleconomics.com/content/dam/diq/online-articles/2014/06/vitalsigns.jpg
@StevenChanMD
time
happy
neutral
sad
Feeling down No pleasure Suicidal plans & intent
unipolar depression
@StevenChanMD
happy
neutral
sad
time
bipolar hypomania bipolar mania
overexcitement euphoria delusions overactivity
bipolar depression
@StevenChanMD
WHY IS MENTAL HEALTH IS IMPORTANT? 10 risk factors contribute to inflammation in depression:
Henry Nasrallah MD. “10 Triggers of inflammation to be avoided, to reduce the risk of depression.” Current Psychiatry 2015 March;14(3):6-7,15. http://www.currentpsychiatry.com/home/article/10-triggers-of-inflammation-to-be-avoided-to-reduce-the-risk-of-depression/0b19d0e64ed3756665ec63921410beae.html
ALLERGY
CHANGES IN GUT PERMEABILITY
OBESITY
SEDENTARY LIFESTYLE
DENTAL DISEASE
POOR SLEEP HYGIENE
POOR DIET
SMOKING
STRESS
LOW VITAMIN D
@StevenChanMD
CAUSES OF DISABILITY
World Health Organization, retrieved 10/2015. http://www.nimh.nih.gov/health/statistics/disability/us-leading-categories-of-diseases-disorders.shtml US Burden of Disease Collaborators. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA, 310(6): 591-608, 2013.
MENTAL & BEHAVIORAL DISORDERS
NEUROLOGICAL DISORDERS
NEUROPSYCHIATRIC DISORDERS CARDIOVASCULAR & CIRCULATORY
NEOPLASMS MUSCULOSKELETAL
DIABETES, UROGENITAL, BLOOD, ENDOCRINE CHRONIC RESPIRATORY
OTHER NON-COMMUNICABLE DISEASES UNINTENTIONAL NON-TRANSPORT INJURIES
SELF-HARM & INTERPERSONAL VIOLENCE TRANSPORT INJURIES
@StevenChanMD
1 in 5 U.S. adults suffer from a mental health condition
in a given year.
https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers
@StevenChanMD
Asian American females have the highest rates of depressive symptoms of any racial/ethnic or gender group.
Young Asian American women ages 15 to 24 die from suicide at a higher rate than other racial/ethnic groups.
Older Asian American women have the highest suicide rate of all women over 65.
@StevenChanMD
Among Southeast Asians…
71%
meet criteria for major mood disorders like depression— with 81% among Cambodians — & 85% among Hmong.
@StevenChanMD
ACCULTURATION
Language barriers
More stigma, racism, bias.
Poorer quality & culturally insensitive care.
Less access to treatment
Less likely to receive treatment.
Lower rates of health insurance.
https://www.nami.org/NAMI/media/NAMI-Media/Infographics/MulticulturalMHFacts10-23-15.pdf
@StevenChanMD
CASE #2 15-year-old cis-♀ schizophrenia.
IMAGE: : https://pixabay.com/en/mom-daughter-asian-family-mother-300296/ USED UNDER CREATIVE COMMONS.
@StevenChanMD IMAGE: : https://www.flickr.com/photos/porsche-linn/7085203423/ USED UNDER CREATIVE COMMONS.
@StevenChanMD
RELIGION
Religion Beliefs Clinical consequences
CONFUCIANISM Reciprocity, benevolence, filial piety, respect for authority, self-development, scholarship
Elder brother or parents may discourage patient from taking medications
BUDDHISM Human life is full of sorrows due to the family’s deeds, one’s own karma and expectations, or one’s desires
The patient accepts mental illness in a fatalistic manner and passively does nothing.
TAOISM Yin = female = softness/darkness/coldness. Yang = male = strength/lightness/heat. Balance achieved by moving vital energy qi / chi.
The patient may seek alternative healing methods to balance qi.
Cultural Psychiatry 2nd edition by Russell Lim
@StevenChanMD
MODEL MINORITY?
https://capac-chu.house.gov/media-center/model-minority-myth
35-40% of Hmong, Laotian, Cambodian populations don’t finish high school.
When 2008 housing market collapsed, AAPIs suffered largest percentage of foreclosures of any racial group.
From 2007 to 2010, AAPIs had the highest share of long-term unemployment of any racial group.
@StevenChanMD
http://blogs.nature.com/naturejobs/2013/01/02/unequal-opportunities-why-arent-there-more-asian-scientists-in-us-leadership-roles
@StevenChanMD
PERFECTIONISM
Obsessive compulsive personality
Obsessive compulsive disorder
Eating disorders (anorexia, bulimia…)
Depression
Social Anxiety
@StevenChanMD
BEYOND APPS: NEW MENTAL HEALTH TECH
https://angel.co/mental-health-3 & @StevenChanMD graphics & analysis
Of the 118 MH startups on AngelList, 70 joined in 2015.
@StevenChanMD
Google | Alphabet
Google’s involvement signals their confidence in technology’s role in one of the most underserved areas of medicine. Alphabet is actively looking at augmented reality, diabetes, geriatrics, & AI in healthcare.
“Technology can cover much of the diagnostic process ... Also, a lot of the treatments for mental health are psychosocial interventions, and those can be done through a smartphone.” — THOMAS INSEL, M.D., SEPT 21, 2015
http://www.technologyreview.com/news/541446/why-americas-top-mental-health-researcher-joined-alphabet/
@StevenChanMD
http://www.wired.com/2015/02/neptune-almost-crazy-idea-upending-smartphone-ecosystem/
SENSORS
@StevenChanMD
Patrick L. Dulin PhD, Vivian M. Gonzalez PhD & Kendra Campbell PhD (2014) Results of a Pilot Test of a Self-Administered Smartphone-Based Treatment System for Alcohol Use Disorders: Usability and Early Outcomes, Substance Abuse, 35:2, 168-175, DOI: 10.1080/08897077.2013.821437
ALCOHOL RELAPSE MONITORING
@StevenChanMD
SPARX cognitive behavioral therapy game
Merry S, Stasiak K et al. The effectiveness of SPARX, a computerised self help intervention for adolescents seeking help for depression: randomised controlled non-inferiority trial. BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e2598 (Published 19 April 2012) http://www.bmj.com/content/344/bmj.e2598. Also covered at http://www.imedicalapps.com/2014/01/video-game-depression-anxiety-kids-diabetes-asthma-linkedwellness/
@StevenChanMD
SPECIFIC PHOBIAS
SOCIAL ANXIETY
ALCOHOL USE
PTSD
RELAXATION Psious
Affordable virtual reality can enhance psychotherapy.
@StevenChanMD
EYE MOVEMENT ABNORMALITIES
1. Benson PJ et al. Biol Psychiatry. “Simple viewing tests can detect eye movement abnormalities that distinguish schizophrenia cases from controls with exceptional accuracy.” 2012 Nov 1;72(9):716-24. doi: 10.1016/j.biopsych.2012.04.019. Epub 2012 May 22.
2. http://www.yalescientific.org/2008/11/the-puzzle-of-autism/ 3. Jones W, Klin A. “Attention to eyes is present but in decline in 2–6-month-old infants later diagnosed with autism.” Nature 504, 427–431 (19
December 2013) doi:10.1038/nature12715
Eye movement tests Schizophrenia Autism
@StevenChanMD
ASYNCHRONOUS TELEPSYCHIATRY
Interviewer
Patient
Courtesy @PeterYellowlees + @StevenChanMD, @UCDavisHealth
Video later routed to psychiatry MD for diagnosis & treatment notes.
FUTURE: Video for data analysis, facial recognition, emotion sensing
@StevenChanMD
ARTIFICIAL INTELLIGENCE FOR PSYCHOTHERAPY
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@StevenChanMD
“ I'm afraid that I'll have an episode one day where I never recover though....it's a really scary thought, it's kind of like cancer in a way.
@StevenChanMD
Know the signs & symptoms.
Know where to go for help.
Nat’l Alliance Mental Illness (NAMI)
ActiveMinds
American Psychiatric Association
Normalize it. Talk about it.
!
@StevenChanMD
STEVEN CHAN, MD MBA Special thanks to Arshya Vahabzadeh, American Psychiatric Assn/SAMHSA Minority Fellowship, UC Davis Psychiatry
DEMYSTIFYING INVISIBLE WOUNDS
IMAGE: https://www.flickr.com/photos/seeminglee/2249001825 BOKEH iMAGE: https://www.flickr.com/photos/stignygaard/5192721433
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