Clinical Remission of Treatment-Resistant Depression, Polysubstance Abuse, and Antidepressant Discontinuation Syndrome Through Engagement of Lifestyle Interventions.

BACKGROUND: This case illustrates the relationship between gut, hormonal, and brain function in that dietary changes, mindfulness interventions, and detoxification led to resolution of disabling psychiatric symptoms and protracted psychotropic medication withdrawal symptoms. SUMMARY: A 50-year-old partnered, unemployed, Caucasian female with a history of major depressive disorder, multiple suicide attempts, extensive trauma and abuse, and substance abuse presented for outpatient management. The patient reported limited benefit from over two decades of conventional treatment with psychotropic medications. She presented with depression and symptoms of protracted withdrawal after self-discontinuation of multiple psychiatric medications and was prescribed a dietary, detoxification, and supplementation regimen by the primary author. Additional lifestyle interventions implemented included daily meditation, dry-skin brushing, and coffee enemas. CONCLUSION: This case exemplifies dramatic clinical remission after cessation of medication treatment and engagement of lifestyle interventions, which include dietary change, meditation, and detoxification. As such, when limited results are achieved by psychotropic medication, tapering combined with dietary interventions as the first-line therapy should be considered. This case is also evidence of the role of lifestyle interventions in treating protracted withdrawal symptoms associated with discontinuing psychotropic medications.

Healing of Dissociative Identity Disorder, Borderline Personality Traits, and Bipolar Disorder Through Lifestyle Interventions: A Case Report.

BACKGROUND: This case report illustrates that the use of a series of lifestyle interventions delivered via the "Vital Mind Reset" online program led to the resolution of disabling psychiatric symptoms. SUMMARY: A 40-year-old, married, Caucasian female, with onset of suicidal ideation as a teenager, was treated with antidepressants and was later formally diagnosed with dissociative identity disorder (DID), borderline personality traits, and bipolar disorder (BD). In the ensuing years, the patient was treated with 35 psychiatric medications. Additionally, she experienced numerous hospitalizations and received over 30 electroconvulsive therapy (ECT) treatments. Despite this extensive conventional treatment, she reported limited gains. In October 2017, the patient committed to the Vital Mind Reset (VMR) online program and implemented a series of lifestyle changes over 44 days, starting with 30 days of dietary, meditation, and lifestyle protocols, followed by supplementation. Notably, the patient has since resolved both physical and psychiatric symptoms including fatigue, acne, migraines, cold sweats, dizziness, nausea, blood sugar crashes, resting tremors, brain fog, anxiety, depression, suicidal ideation, auditory hallucinations, and delusions. In this patient's case, hypertension, bradycardia, headaches, increased frequency of mania, tremors, insomnia, and weight gain accompanied her medications. This case exemplifies the dramatic resolution of disabling psychiatric symptoms after engagement in the lifestyle interventions outlined in the VMR program, medication taper, and supplementation. When medication demonstrates limited clinical yield and a plethora of side effects, tapering combined with lifestyle interventions and supplementation should be considered as first-line therapy. This case is evidence of the potential for healing and resolution of severe and persistent psychiatric illness with dietary and lifestyle changes.

Schizophrenia Symptom Alleviation Through Implementation of a Lifestyle Intervention Program.

BACKGROUND: This case report illustrates the use of a lifestyle intervention program entitled "Vital Mind Reset" which led to the alleviation of disabling schizophrenic symptomology. SUMMARY: A 22-year-old male with onset of Tourette's Syndrome and depression with suicidal ideation as a teenager began declining in mental vitality, resulting in the eventual diagnosis of treatment-resistant schizophrenia at the age of 17. At this time, he was admitted to an adolescent mental health ward due to delusional thinking and auditory hallucinations. Despite administration of a multitude of antipsychotic medications throughout the ensuing years, he was admitted yearly to the same hospital during the winter months until 2015. The patient began the Vital Mind Reset (VMR) program in 2017, committing to a series of lifestyle interventions which included dietary modifications, daily meditations, and detoxification practices. After completing the program, the patient experienced significantly improved quality of life, as he was once again able to leave his house. One year after completing the program, his physicians reported his schizophrenia appeared "to be in remission." Given these results, when medication and conventional therapies gain limited progress, lifestyle interventions outlined in the VMR program should be considered, perhaps even as first-line therapy. This case defies the chronicity of severe psychiatric symptomologies such as schizophrenia and exemplifies the potential for healing and resolution of persistent psychiatric illness.

Successful Discontinuation of Chronic Polypsychotropic Regimen and Resolution of Withdrawal Syndrome Through Nutrition and Lifestyle Interventions: A Case Report.

BACKGROUND: A 38-year-old, female with a history of GAD, MDD, AN, and PTSD wanted to taper her multiple medications in preparation for pregnancy. Benzodiazepine medications, such as Klonopin and Restoril; antidepressants, such as Effexor; and anticonvulsant medications, such as Lamictal, can be habit-forming, and withdrawal symptoms can occur upon discontinuation of use. Polypharmacy can be implicated in poor clinical outcomes, and a strategic and supported medication taper may improve those outcomes. SUMMARY: After the primary MD unsuccessfully attempted to taper off the patient's psychotropic medications without lifestyle interventions, she was stabilized on a minimal regimen by an outside reproductive psychiatrist throughout her pregnancy. A second tapering was implemented by the primary MD after the patient had given birth and had established changes to her lifestyle. These lifestyle interventions included dietary changes, use of detoxification protocols, contemplative practices, and strategic supplement support in the setting of a powerful mindset shift. The patient experienced remarkable symptom remission after strategic discontinuation of medications through the addition of the lifestyle interventions. She also was able to heal the root-cause drivers of her psychiatric diagnoses. Currently she is symptom-free and medication-free after nearly 21 years. CONCLUSIONS: This case demonstrates the effectiveness of lifestyle interventions and psychospiritual support to enable dramatic clinical change without withdrawal syndrome after cessation of medication. More important, the initial failed tapering underpins the notion that a diligent meditation practice may be necessary to heal root-cause drivers of psychiatric symptoms and withdrawal syndrome. The results may serve to inform practitioners assisting patients who wish to discontinue benzodiazepine and other psychotropic medications or patients who would like to try a nonpharmaceutical approach as a first-line therapy.

Healing of Graves' Disease Thorough Lifestyle Changes: A Case Report.

BACKGROUND: Graves' disease is known as a chronic and incurable disease. The typical treatment is symptom-based and consists of medications, radioiodine, or surgery. These last two treatments are routinely offered to the 50% of patients that do not respond to drug therapy. Here we report the case of a patient who was able to normalize her thyroid hormones as well as her autoimmune markers in 6 months with the exclusive implementation of lifestyle interventions. SUMMARY: A 34-year-old Dutch, Caucasian female diagnosed with Graves' disease since 2014 implemented lifestyle modifications, which included dietary change to an ancestral type of diet, oral health interventions, practice of kundalini yoga, avoidance of environmental toxicants (by only eating organic food, drinking filtered water, and using natural products to clean her house or for her personal hygiene) and supportive supplements when necessary. The patient did not take any antithyroid drugs or beta-blockers during this period nor any other type of medication that could have had immunosuppressant effects. After 6 months of engaging in these lifestyle interventions, her thyroid analysis normalized and no anti-thyrotropin receptor antibodies were negative. CONCLUSION: This case report demonstrates that Graves' disease can effectively be put into lasting remission without conventional medical interventions. It also emphasizes the importance of a healthy lifestyle as a first line intervention for all patients but especially in the particular case of patients suffering from Graves' disease.

Treatment Emergent Violence To Self And Others; A Literature Review of Neuropsychiatric Adverse Reactions For Antidepressant And Neuroleptic Psychiatric Drugs And General Medications.

OBJECTIVE: This paper reviews the literature linking physical violence, directed towards self or others, to serotonergic and dopaminergic psychiatric drugs and general medications. DESIGN/METHODOLOGY/APPROACH: Data about side effects, pharmacogenetics and homeostasis are obtained from articles, electronic Medicines Compendium, DSM-IV-TR, British National Formulary (BNF) and academic books. Statistics have been obtained from articles, The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Risk, Manchester, Mental Health Equalities, National Mental Health Development Unit and the NHS Health and Social Care Information Centre. Classification for neurotoxic conditions and mental illness are obtained from the DSM-IV-TR, DSM-V and ICD-10. FINDINGS: Psychiatric drugs and some general medications have effects that are not always the ones intended. Reactions to different drugs and drug-drug combinations are governed by individual metabolising rates. Phase 1 metabolism takes place via the cytochrome P450 enzymes with 57 human genes identified that are genetically variable i.e. polymorphic. The population are coded as poor, extensive (known as normal), intermediate or ultra rapid metabolisers. Variations in the serotonin transporter gene (5-HTTLPR) and serotonin receptors (5-HT) influence the outcome of serotonergic medications. It is established genetic polymorphisms in the CYP450 and serotoninergic metabolising system cause higher drug blood levels which are associated with neuropsychiatric adverse drug reactions (ADRs), such as akathisia. If not recognised, akathisia, which often precedes violence, suicidality, homicide, mania and psychosis, may be mistaken for new or emergent mental illness and treated with further ineffective, counter-productive psychiatric drugs. RESEARCH LIMITATIONS/IMPLICATIONS: The absence of pharmaceutical data for CYP450 diminishing, null/non- functioning or multiple polymorphisms and variations in the 5-HTTLPR and 5-HT, linking general medications and psychiatric drugs with neuropsychiatric behavioural reactions is notable. There is limited information linking psychiatric drug disruption of homeostasis and neurotransmitters with violence. These issues indicate a need for greater pharmaceutical transparency and further research into the role of CYP450, 5-HTTLPR and 5-HT polymorphism associated neuropsychiatric ADRs for all psychiatric drugs and serotonergic general medications. PRACTICAL IMPLICATIONS: Safer prescribing is important and could be achieved by individual genotype testing, which would identify persons with genetic polymorphisms, who are unable to metabolise drugs. Prevention of violence would enhance peoples' well being, ground floor practitioner and public safety. CONCLUSION: This paper is the first review that implicates certain drugs as a cause of violence due to pharmacogentic polymorphisms and neurotransmitter disruption.

Psychotropic Drug Withdrawal and Holistic Tapering Strategies: A Case Series.

This case series aims to further the understanding of psychotropic drug withdrawal symptoms, as well as how individuals may be supported using holistic approaches for long term mood support. A secondary objective is to contribute to the evidence base for differentiating psychotropic drug withdrawal from the resurgence of psychiatric symptoms. Patients are described in two groups based on the timeline of psychotropic tapering. Group A illustrates cases of tapering safely from psychotropic medications under the supervision of the author of this case series, and Group B describes cases of individuals who sought mood support for protracted withdrawal symptoms. Both groups were treated with dietary changes, mindfulness practices, detoxification-supported gut health protocols, hormonal regulation, and treatment of comorbidities. Use of complementary medicine reduced many of the acute symptoms of psychotropic drug withdrawal, such as sleep disturbances, decreased concentration, nausea/headaches, and depression, making the process more manageable for patients. Additionally, many of the initial psychiatric complaints were kept in remission. These methods present a sustainable alternative to long-term treatment of mood symptoms and comorbid chronic illnesses. This case series indicates the benefits of integrating holistic and conventional medicine in psychotropic drug tapering, and a call for further trials to create an evidence-based database to guide future treatment and taper protocols.

Resolution of Refractory Bipolar Disorder With Psychotic Features and Suicidality Through Lifestyle Interventions: A Case Report.

Background • This case illustrates the relationship between gut, hormonal, and brain function in that dietary change, mindfulness interventions, and detoxification led to resolution of disabling luteally exacerbated psychiatric symptoms. Summary • A 45-y-old, married, Caucasian female with a history of diagnosed bipolar disorder with psychotic features, premenstrual dysphoric disorder, panic disorder, and repeated occurrence of suicide attempts and self-mutilating behavior presented for outpatient management. She reported limited gains through conventional treatment consisting of medication. The patient was prescribed a dietary, detox, and meditation regimen for 1 mo, after which supplementation was added to support detoxification, digestion, hormonal balance, and nervous system structure and function. Additional lifestyle management therapeutics included daily meditation, dry-skin brushing, and coffee enemas. Conclusion • This case exemplifies dramatic clinical remission after cessation of medication treatment and engagement of lifestyle interventions, which include dietary change, meditation, and detoxification. When medication demonstrates limited results, tapering combined with dietary interventions as the first-line therapy should be considered.

Remote Healing of Bipolar Disorder, Eating Disorder Not Otherwise Specified, Posttraumatic Stress Disorder, Fibromyalgia, and Irritable Bowel Syndrome Through Lifestyle Change.

This case report illustrates the relationship between gut, hormonal, and brain function in that dietary change, mindfulness interventions, and detoxification led to resolution of disabling psychiatric symptoms. In this case, a single Caucasian female resolved her symptoms of bipolar disorder (BD) including psychotic features and suicidality, posttraumatic stress disorder symptoms from childhood torture, disordered eating, fibromyalgia, and irritable bowel syndrome through lifestyle interventions. This patient survived a severe trauma history only to develop alcohol dependence, disordered eating, and depressive symptoms, which were treated with a polypharmaceutical psychiatric approach. She was formally diagnosed with BD after being treated with antidepressants and went on to be treated with up to 15 medications in the ensuing years. Disabled by the side effects of her treatment, she worked with her treating psychiatrist to taper off of 4 medications before she learned of nutritional change through a book authored by the author. After completing 1 mo of these recommendations including dietary change, detox, and meditation, she enrolled in the author's online program and went on to resolve her symptoms, physical and psychiatric, to the extent that BD has been removed from her medical record. She has been symptom free for 1 y. This case is evidence of the potential for self-directed healing and resolution of chronic illness.

Psychobiology of Vaccination Effects: Bidirectional Relevance of Depression.

Emerging research on inflammation-mediated processes that underpin depressive syndromes reveals a possible link warranting greater exploration. Because of its often insidious onset and varied presentation, depression as a sequelae of pharmaceutical interventions can be difficult to assess. This review explores the available literature considering the relevance of pre-existing depression to vaccination response as well as the association of vaccination with adverse psychiatric events/depression and the mechanistic plausibility of that association.

Perinatal depression and anxiety: beyond psychopharmacology.

A discussion of pharmacologic and nonpharmacologic management of mental disorders in the pregnant woman is presented, with the focus on alternative health approaches and nutrition awareness. The article explores some considerations of modifiable risk factors thought to play a role in epigenetic manifestations of infant and child illness. Several case examples show the potential for integrative medicine in patients of reproductive age.

Effect of creatinine clearance on patterns of toxicity in older patients receiving adjuvant chemotherapy for breast cancer.

OBJECTIVE: A number of age-related physiological changes contribute to an increased risk of toxicity of cancer chemotherapy in the elderly. One of the most important of these changes is the progressive decline in renal function with aging. We sought to determine the association between calculated creatinine clearance (CL(CR)) and grade 3 or 4 toxicities during adjuvant chemotherapy in women > or =65 years of age with breast cancer. DESIGN AND METHODS: We identified 1405 patients > or =65 years of age who had been treated for primary invasive breast cancer at Memorial Sloan-Kettering Cancer Center between January 1998 and December 2000. Patients were included in this analysis if they had stage I-III breast cancer and had received adjuvant chemotherapy. Patients were excluded if they had a prior history of breast cancer or chemotherapy, or had no baseline creatinine value available for review. RESULTS: The 126 patients who met our criteria had received either cyclophosphamide, methotrexate and fluorouracil (CMF) [n = 65, mean age 71, range 65-78] or an anthracycline-based regimen (n = 61, mean age 69, range 65-79). The majority of patients (97%) had a normal creatinine. CL(CR), as calculated by the Cockcroft-Gault and Jeliffe formulas, decreased with increasing age (increased age associated with decreased Cockcroft-Gault [p = 0.02]; increased age associated with decreased Jeliffe [p < 0.01]). In multivariate analysis, after controlling for age and co-morbidity, a CL(CR) <50 mL/min by the Cockcroft-Gault formula was associated with an increased risk of fever and neutropenia (odds ratio [OR] 3.60; 95% CI 1.00, 12.94; p = 0.05) and a CL(CR) <50 mL/min by the Jeliffe formula was associated with a trend towards an increased risk of fever and neutropenia (OR 3.30; 95% CI 0.91, 12.33; p = 0.07), grade 3 or 4 haematological toxicity (OR 2.43; 95% CI 0.90, 6.55; p = 0.08), and need for erythropoietin (OR 4.15; 95% CI 0.81, 2.99; p = 0.09). An increase in creatinine (as a continuous variable) was associated with a trend towards an increased risk of grade 3 or 4 haematological toxicity (OR 5.81; 95% CI 0.96, 35.33; p = 0.06). CONCLUSIONS: In this cohort of older breast cancer patients, a decreased CL(CR) and increased creatinine was associated with an increased risk of fever and neutropenia or haematological toxicity. CL(CR) should be considered when determining chemotherapy dosage in the elderly.

Patterns of toxicity in older patients with breast cancer receiving adjuvant chemotherapy.

OBJECTIVE: To retrospectively determine the relationship of age to toxicity from adjuvant chemotherapy for breast cancer. DESIGN AND METHODS: We identified 1,405 consecutive patients age 65 or older with primary invasive breast cancer who were seen at Memorial Sloan-Kettering Cancer Center from January 1998 to December 2000. Patients selected from this cohort for analysis were aged 65 or older at diagnosis; received their follow-up care at Memorial Sloan-Kettering Cancer Center; had stage I, II, or III breast cancer; and received adjuvant chemotherapy consisting of CMF (cyclophosphamide, methotrexate, and 5-fluorouracil), an anthracycline-based regimen (AC [doxorubicin and cyclophosphamide], or AC-T [AC and paclitaxel or docetaxel]). Exclusion criteria included prior chemotherapy or previous breast cancer. RESULTS: One hundred thirty-two patients were included in this study, with a mean age of 70 (range 65--79). Comorbidity measured by the Charlson comorbidity index was low: score 0 (83%), 1 (12%), 2 (5%); with stages: I(18%), IIA (41%), IIB (27%), IIIA (8%), IIIB (6%), T1Nx (1%). Patients receiving an anthracycline-based regimen were more likely to experience grade 3 or 4 toxicity (p=0. 01), require hospitalization (p<0.001), and/or develop febrile neutropenia (p<0.001). Treatment delays due to myelosuppression occurred more frequently in patients receiving CMF (p<0.001). The type of chemotherapy regimen (anthracycline compared to CMF) was a better predictor for toxicity than increased age or comorbidity score. CONCLUSIONS: In this cohort of older patients with breast cancer, the risk for toxicity from adjuvant chemotherapy depended more on the type of regimen (anthracycline vs. CMF) than the patient's chronological age.

The International Confederation of Midwives' study of essential competencies of midwifery practice.

OBJECTIVE: To delineate the knowledge, skills, and behaviours that would characterise the domain of competencies of the midwife who is educated according to the international definition of the profession. DESIGN: Phase I: a qualitative Delphi study; Phase II: a descriptive survey research process. PARTICIPANTS: A stratified random sample of member organisations of the International Confederation of Midwives (ICM) and regulatory representatives from these same countries. FINDINGS: A list of basic (essential) and additional competencies for midwives who have been educated in keeping with the ICM/WHO/FIGO international definition of the midwife was developed through an interative Delphi process, and then affirmed, using a survey research method. The final list includes 214 individual task statements within six domains of midwifery practice. IMPLICATIONS FOR PRACTICE: This list of competencies can serve as a basis for educational curriculum design, as a guideline for regulatory policy development, as a reference document for individual practitioners in an assessment of their initial and continued competency and by the ICM and its member associations as a resource for advocating for the role of midwifery within health-care systems world-wide.