January 2007 | Back to Table of Contents

Pulse

Facing Fear

You enter a tiny room on the second floor of the University of Minnesota Medical Center, Fairview Riverside campus, put on a black helmet that looks as if it might belong to Darth Vader, and settle into an arm chair. A voice asks if you’re ready. You nod and then see that you’re sitting in a plane. A flight attendant is talking above the din of the other passengers and the steady hum of fans and idling engines.

Suddenly, you feel vibration through your feet and hear the roar of engines revving. You look out a window and see that you’re speeding down a runway past snow-spotted fields. Then you feel a clunk and hear a whining sound as the wheels retract. You’re terrified. The voice coming through your headset tells you to take deep breaths and that the sounds, shakes, and sights that you’re experiencing are a normal part of every flight.

The voice belongs to Chris Donahue, Ph.D., L.P., an assistant professor in the department of psychiatry at the University of Minnesota who for the last year and a half has been using a virtual reality system to treat patients with fears ranging from acrophobia to arachnophobia.

Virtual reality is a tool for doing exposure therapy, Donahue says, but not a magic bullet. Patients also undergo talk therapy and have homework assignments such as listening to tapes or doing an anxiety-inducing task such as riding a roller coaster. Donahue says exposure therapy usually requires six to seven sessions.

In addition to helping patients conquer their fears, the virtual reality system is a useful research tool. This winter, Donahue and colleague Matt Kushner, Ph.D., will launch a study on the efficacy of the antipsychotic drug quetiapine for anxiety using software that simulates a public speaking engagement. Subjects will be asked to present before a virtual audience after receiving quetiapine or placebo. “It’s a standardized program that can be used in research and has shown good efficacy in the treatment of individuals with anxiety,” Donahue says.

To learn more about virtual reality therapy, call 612/273-8710; to find out about the research project, call 612/273-9868.—Carmen Peota

Mixing Science and Spirit

The Chemistry of Joy: A Three-Step Program for Overcoming Depression through Western Science and Eastern Wisdom. By Henry Emmons, M.D. (with Rachel Kranz) New York: Fireside, 2006.

In his new book, Minnesota psychiatrist Henry Emmons, M.D., outlines his three-step, holistic approach to overcoming depression, which draws from Western biochemistry, an ancient Indian approach to mind-body medicine, and Buddhist psychology. A student of Jon Kabat-Zinn, Ph.D., who introduced doctors to the concept of mindfulness-based stress reduction, Emmons describes three types of depression—anxious, agitated, and sluggish—and discusses how understanding brain chemistry, the role of diet and physical activity, mental outlook, and openness of spirit are the keys to overcoming each.

Screening Pays

Providing additional depression screening and care may save employers money in the long run, according to a study by researchers from Brigham and Women’s Hospital and Harvard Medical School in Boston and the National Institute of Mental Health in Bethesda, Maryland.

Investigators constructed a computer model to analyze the costs and benefits associated with a program that screens all employees for depression, then provides telephone counseling and other strategies for managing depression to those who test positive.

The analysis showed that after five years, an employer could save nearly $3,000 per 1,000 workers because of reduced absenteeism, presenteeism, and employee turnover.

The researchers published their findings in the December issue of Archives of General Psychiatry.

Suicide Watch

According to the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control, 5,393 people in the United States older than 65 committed suicide in 2001. Of those, 85 percent were men.

Government studies also showed that the majority of elderly men who committed suicide had been seen by their primary care physician weeks before their attempt and were diagnosed with their first episode of depression. In addition, suicidal individuals are likely to be suffering from physical illnesses and divorced or widowed.

Seniors aren’t the only ones to whom physicians should pay close attention. Last month, a Food and Drug Administration panel recommended that drug-label warnings on antidepressants about the risk of suicidal behaviors and thoughts be expanded to include persons up to 25 years of age. Since 2004, antidepressants have carried black-box warnings about suicidal risks for children and adolescents. The FDA based its decision on a review of 372 studies of 100,000 patients and 11 antidepressants, according to Associated Press reports.

Palm Readings

University of Minnesota researchers are hoping to find clues to understanding anorexia nervosa in the palm of the hand.

A team led by professor of psychiatry Scott Crow, M.D., is recruiting subjects who have been diagnosed with anorexia to take part in a study that will have them use PalmPilots to document their behaviors and feelings.

Participants will be given a PalmPilot that is programmed to ask them questions about what they are thinking and feeling six times a day for two weeks. They will record their answers as well as information about when they eat or engage in certain behaviors into the handheld device. The goal of the study is to develop a model for predicting symptoms of anorexia based on personality traits, mood, and feelings.

For more information or to have a patient considered for enrollment, call 612/627-1991 or send an e-mail to anpalm@umn.edu.

Biggest Gripes

A survey of 647 psychiatrists in the United States found only 9 percent were not frustrated by the constraints of practicing in today’s marketplace.

Respondents’ biggest complaints? Thirty-three percent cited administrative and business agendas interfering with their clinical decisions; 19 percent said reimbursement and issues related to it; and 13 percent complained of spending too much time at work.

The survey was conducted last summer by LocumTenens.com, an Alpharetta, Georgia, physician staffing agency.