Many times ADD/ADHD and bipolar are hard to distinguish from each other. ADD behavior is consistent and is driven more by interest than by importance. Bipolar is cyclic and behavior is driven by mood. Many people have both disorders. 60% of those with ADD will also be bipolar.

On 9-14-04 I made a diary entry after the baseball incident where a pitcher threw a chair into the stands. In the baseball incident, I was most perplexed by the lack of any commentary about the fans’ roles in the problem or their inappropriate behavior. Now this weekend we had the Detroit incident where players went into the stands and players and fans were punching each other. What is up with all this insanity?

On Sunday following the incident, NBA commissioner David Stern made a comment. Punishments were quick and harsh. What impressed me the most about his comments was that he included the fact that the league will make changes that also regulate the fans’ behavior. 

A previous incident where a basketball player went into the stands was provoked by a fan taunting him about the death of his child. I hope that the public will get behind the NBA in mandating civilized behavior by the fans. Earl Warren is reported to have said - "I can’t give you an exact definition of pornography, but I know it when I see it."

We know when a fan has crossed the line and become abusive, and we all need to help security promptly and effectively deal with these individuals. Some of the fans in Detroit should face criminal charges and suspensions from attending games for the season.

I was disappointed when USA Today came out Monday morning - Page 1 Headline - "Pacer Suspended for Season", "Is Game Out of Control?" The story takes up 1/2 of page 1 and 1/2 of page 2, but the article fails to mention the need for standards to regulate fan behavior.

I will do an article soon about the physiology and treatment options for inappropriate aggression.

Did you know that testosterone increases aggression? 

And did you know that athletes on the winning team and their fans have an increase in testosterone after the game? 

Did this contribute to Ron Artest going up into the stands? 

The corollary to the testosterone increase is that the losing team and their fans have a decrease in their testosterone. I have been a Cubs fan for over 50 years - no wonder I’m not a fighter.

Related Article: Violence in Sports …

I like the word "stress", and I find that patients accept the word and the concept. It helps answer the question, "why am I so screwed up?" It certainly beats words like "schizophrenia", "manic depressive" and "neurosis." "Borderline personality" never sold well.

Change starts with awareness. Only when you know what the problem is can you make a decision to change. If you don’t pay now with good stress management, you will pay later with "wear and tear." The process of change is really a lifetime commitment to take responsibility and maintain balance. Of course it helps to be lucky.

Many studies show that stress symptoms and disorders are increasing. Not only are more people becoming clinically depressed, but it’s starting at an earlier age. Suicide is second only to accidents in cause of death in teenagers. The average adult weighs 30 pounds more than in 1970. Stress is a major contributor to complaints of fatigue, headaches, anxiety, insomnia, poor concentration, lack of interest in sex, digestive problems, and high blood pressure. The list goes on and on.

You can think of stress symptoms as being like debts in your STRESS ECONOMY. IF your deposits (stress management) are less than your withdrawals (stress), this creates stress overload. Sometimes symptoms are caused by too many concurrent pressures (changes) but other times by a decrease in stress management.

A man came to me complaining of recent onset of panic attacks. He seemed to have everything going for him. He was in good general health, was financially well off, and had a great marriage. BUT, he did have a high volume business in a competitive market.

My assessment of why he suddenly started having symptoms is that he had stopped his daily thirty minute jog. He had fallen while working on a home improvement project and was a walking cast. Many people who don’t have any symptoms are susceptible to one sudden change or loss pushing them over the line and out of balance.

Selye defined stress as “the wear and tear of life” or, more specifically, that which increases your Cortisol (stress hormone).

If I had to put one word between life’s stresses and illness it would be Cortisol. Cortisol is essential for life. In a crisis Cortisol “marshals your troops to the front line” - BUT at the expense of longer term concerns like your immune system and less essential functions in an emergency, like digestion and sexual functioning. Chronic stress overload suppresses your immune system. This means not only increase in susceptibility to infection but can ultimately cause cancer that may not become symptomatic and diagnosed until years later. A study of dental students found that wounds took 40% longer to heal before exams than before the semester started and that their immune function before exams was reduced by 2/3’s. Stressors can be obvious. Travel is more difficult since 9-11. We all have some level of concern about the dangers associated with terrorism. But there’s the more mundane - traffic, deadlines, tests, conflicts, health insurance - an almost endless list of external issues that are far more complex than ever in history. There are also internal stressors - attitudes and expectations that we have. We put pressure on ourselves, and we sometimes dwell on past mistakes or worry excessively about the future.

More important than stressors themselves is how much control we have. When mice were experimentally shocked until they pressed a certain lever, and this was repeated over and over, they did not show much elevation in Cortisol. But when these mice are connected to a 2nd group of mice, who don’t have the levers but get exactly the same amount of shock as the 1st group, the 2nd group (without the levers) become agitated initially, but then give up and become passive. Their Cortisol levels are extremely elevated. Being helpless is more stressing than being shocked. It also shows that chronic stress eventually leads to exhaustion and fatigue. If the 2nd group of mice is given access to levers after they have reached this last stage, they don’t even try to use them. This has been called “learned helplessness” by Seligman. In today’s highly complex society, we have much less control than our ancestors. I remember a tax law change that lowered the value of the office condo I owned by 80%. Seventeen years later, it’s still worth only 1/2 of what I paid for it. Stress!

Another factor that alters the the effect of a stressor is predictability. Studies done with primates by Coplan dramatically demonstrate this. New mothers were put in one of 3 situations relative to getting food for themselves and their babies.

Food was either easily available, or required hard work and looking, or it varied between the two conditions. The mothers in the unpredictable situation became highly stressed. Importantly, so did their babies. Most importantly, these babies grew up to become adults who had permanent vulnerability to stress.

This study has also documented the effects on the brain of the stress syndrome. They had much lower survival rates of new brain cells, especially those in rapid access memory part of the brain.

There are other factors that influence how we react to stress.

• Genetics - animals can be bred to be overreactive to stress or to be highly resilient and less than average in their stress responses.
• Gender (sex) - women between puberty and menopause are more reactive to stress than men. When asked to dwell on the worst experience of their life, women had 8x’s more activity in the areas of emotional processing in the brain as men doing the same exercise. After 9-11, men were angry and increased their physical activity. Women were more emotional, worried about their loved ones, and had more symptoms.

One of the most important determinants of stress reactivity is early life experience. Even in utero, the fetus is impacted by the mothers stress symptoms. Clinical depression during pregnancy increases stress vulnerability in the infant and this effect is long lasting. One of the most controllable factors in stress reactivity is clinical depression itself. Stress reactivity, more than stress itself, determines response. Early recognition and adequate treatment to full remission is protective.

Just as physical exercise can make you stronger, manageable stress makes you more resilient. Animal studies show that brief separations of babies from their mothers followed by nurturing led to resistance to adversity. This has been called “Stress Inoculation”.

The following will also help reduce stress symptoms:

• Getting rid of unnecessary stresses
• Resolving ongoing disputes
• Being proactive
• Attending church or having a meaningful spiritual life
• Having strong relationships and social support
• Having a good sex life
• Doing physical activities
• Getting 7 hours of quality sleep every night

? Body dysmorphic disorder
• Hypochondriasis
• Anorexia nervosa/Bulimia
• Tourettes syndrome
• Tics
• ADHD/ADD
• Trichotillomania (hair pulling)
• Pathological gambling
• Addictions
• Asperger’s

? OCD is like the brain getting ‘stuck in gear? unable to shift to another thought
• 2% to 3% of Americans, or 1 in 50 are affected by OCD
• Onset of OCD is usually in adolescence or early adulthood
• Studies show a gap of 17 years between onset of symptoms and treatment
• OCD is more common than asthma or diabetes

Classic OCD starts with a thought, “what if?”. Obsessive thoughts lead to compulsive behaviors. The serotonin system in the brain is overactive. Medications that increase serotonin make OCD worse. Every medicine that significantly helps OCD is a Reuptake Inhibitor of serotonin, or SSRI.
When an SSRI is taken initially, (within the first 24 hours), serotonin is increased. This happens because there is an increase of serotonin in the synapse between nerve cells. After taking the medication for several weeks the serotonin down regulates (reduces) the receptors and production of serotonin decreases. Patience is required to see the full effect of the medication because it sometimes takes 3-4 months to achieve. However, high doses are frequently needed.
Adding Klonopin is often helpful because it helps decrease serotonin activity. Studies show a success rate of between 50 and 80 percent improvement by individuals treated with medication only. However, medication works best when combined with cognitive and behavioral therapy.

I always insist that my OCD patients listen to or read Brainlock, by Jeffrey Schwartz. The book not only explains effective cognitive behavioral techniques, but also teaches how to do “self talk.” This helps reduce OCD behavior. Schwartz and his UCLA colleagues also demonstrated that doing these techniques not only decreases OCD symptoms, but actually changes the biochemical abnormalities in the brain. This is verified by brain scans.
The basic concept is easy to learn. But like playing tennis, knowing what to do is a lot easier than being able to consistently do it. It takes hard work and persistence.
Think of OCD as a bully that wants to run your life. Develop an attitude of aggressiveness that you are going to be in charge.
BRAINLOCK:
STEP ONE: Relabel
•It’s not me, it’s my OCD!?
STEP TWO: Reattribute
•It’s my high serotonin!?
STEP THREE: Refocus
Shift the mind to an activity that is of interest to you.
STEP FOUR: Revalue
This is not a real danger. It is an irrational thought. Compulsive rituals are a waste of time!
The most important and also the hardest step is refocusing.
Experiment with approaches:
• Visual (read something)
• Auditory (listen to music)
• Kinesthetic (exercise)
• Combine any of the above
Each person has to find what works best for them. It also helps to get a spouse, friend, or family member to listen to the tape or read the book. This will ensure a good support system for staying with the program until an improvement of symptoms is achieved.
Behavior therapy has proven to be effective in 60 to 90 percent of OCD patients.