@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

?

@StevenChanMD

CASE #1 18-year-old Chinese cis-♀ with mania.

This could happen to any of us.

@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

Dragon child expectations

@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

WARNING SIGNS

Depressed mood

Suicide plans & intention

Drugs & alcohol use

@StevenChanMD

@StevenChanMD

Transcultural Wellness Center

@StevenChanMD

@StevenChanMD

@StevenChanMD

@StevenChanMD

BUSINESS COACHING

@StevenChanMD

@StevenChanMD

CASE #3

@StevenChanMD

@StevenChanMD

@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

AVATARS

http://ict.usc.edu/prototypes/simsensei/

MultiSense SimSensei

@StevenChanMD ..

BRAIN POWER SYSTEM Wearable Educational System for Autism

@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 Courtesy Helen S. Koo PhD, @UCDavis — http://helenskoo.com

WEARABLE TECH + CLOTHING

@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

Fragmented systems create opportunity for new mental health platforms.

@StevenChanMD

CASE #1 18-year-old Chinese cis-♀ with mania.

Here’s her recovery.

@StevenChanMD

time

medicines

talk therapy

calm environment

friendship & support

happy

neutral

sad

@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

?

@StevenChanMD