Insomnia Medication

Save the Date Fall 2006 www.sacpsy.org I t’s time to update your information on our website! Contact Dr. Paul Mattiuzzi ma2z@surewest.net to set up your practice profile, make announcements, or to place an item on the SVPA bulletin board. The website gets a large amount of hits, and has proven to be a great resource for prospective mental health clients seeking a psychologist. Medication Insights Insomnia or Sleep Disorders In This Issue Medication Insights 1 Biographical Sketch 2 Become A Red Cross Volunteer 3 SVPA’s Dinner Meeting 6 Who or What is CLASP? 8 Meet Dr. Jill Landerholm 9 Book Review 10 President’s Message 11 CPA Lieison Report 12 T Fred Raleigh, Pharm.D., BCPP Advertising Rates for The Sacramento Valley Psychologist business card: 1/4 page: 1/2 page: full page: $50 $75 $150 $200 he problem of insomnia or sleep disor- nonrestorative sleep, or a condition where der has just recently begun to receive the patient cannot really specify the probthe attention it deserves. Interestingly a lem-they just awaken and feel unrefreshed recent National Institute of Health (NIH) or unrestored. Most insomniacs wake feeling consensus report on insomnia released in drowsy or tired. If any of these problems lister above lasts just for a night or 2005 felt that chronic insomnia two or a week or so it is referred was an important condition.* Insomnia is to as transient insomnia. Yet, if Though this may not seem a problem of the problem persists but is off important it was just 22 years and on over just a few weeks it ago that the first NIH conseninadequate or can be thought of as intermittent sus report (1983) on chronic insufficient insomnia reported that chronic sleep despite an insomnia. Finally, when any of these problems occurs 3 or more insomnia was a possible probadequate times a week and last for a month lem. opportunity. or more it is considered chronic In the following article we and on-going insomnia. will define the problem, review Chronic insomnia is further broken down the causes of insomnia, look at treatment modalities and finally review some useful into several types. One type is primary insomweb sites that offer on-line support and nia where there are complaints of sleep quality information for those suffering from sleep with no underlying health problems detected; while the other types are now named after the disorders. How do we define insomnia? We can temporal patterns of sleep. These temporal begin by saying that the condition is a patterns used to be collectively called secondsymptom, not a disease. Insomnia is a ary insomnia where there was not only sleep problem of inadequate or insufficient sleep problems but there were also issues related despite an adequate opportunity. As stated to: physical health problem[s] (i.e. cancer, insomnia is a problem associated with poor asthma, arthritis), drugs or medications, quality sleep. As such, the problem is bro- stress or mental health problems (depression) ken down into several types of difficulty or a poor sleep environment i.e. to much light or noise or a partner who snores. Now with regard to falling or staying asleep. It is also important to realize that insom- instead of using the term secondary insomnia nia is not just a problem associated with we use the term temporal patterns. There are falling asleep (onset) but is also a prob- four forms of temporal patterns which are: Continued on page 4 lem that encompasses sleep maintenance (difficulty staying asleep), or waking to *See the last web site hyper link listed at the end of this early. Insomnia may also be a problem of article.  The SACRAMENTO VALLEY PSYCHOLOGIST Fall 2005 Biographical Sketch Fred Raleigh, Pharm.D., BCPP July 2006 D r. Raleigh, a Board Certified Psychiatric Pharmacist, is currently serving in a consulting capacity after recently retiring as a Pharmacy Services Manager for Health Care Services, California Department of Corrections and Rehabilitation (CDCR), where he had shared oversight responsibility for prison pharmacy policy, procedures, budget, training and other duties as deemed necessary. During his tenure with CDCR Fred also provided consultative services to the Juvenile Justice division of CDCR. Fred is a clinical professor of pharmacy at the University of California at San Francisco School of Pharmacy and an adjunct assistant professor of pharmacy practice at the University of Southern California School of Pharmacy. Dr. Raleigh has also been actively involved in his professional organizations at the state and national levels. He is a founding member of the College of Psychiatric and Neurological Pharmacists (CPNP). In 1996 Fred was named Mental Health Pharmacist of the Year. Fred has worked in the community for over twenty-five years as a health care educator and medication consultant pharmacist for local skilled nursing facilities, Tri-Counties Regional Center and for private patients. Dr. Raleigh has also been involved as an expert witness having served the needs of both the defense and prosecution in numerous legal cases. Dr. Raleigh has published and presented over 130 articles dealing with the rational and safe use of medications in our culture and advancing the image of pharmacy as a profession. Fred also serves as a reviewer for the Annals of Pharmacotherapy, Psychiatric Services, American Journal of HealthSystem Pharmacy, Pharmacists’ Letter and is a past member of the editorial review board for the California Pharmacist. Dr. Raleigh has also served on several advisory boards for the pharmaceutical industry. Finally, Fred writes a monthly medication and health issues question and answer column in “Plus”, a magazine distributed in Central Coastal California. Fred has a number of hobbies and outside interest including traveling, writing, cooking, and being a father/mentor to his two sons David and Evan.  SVPA Board Catherine Cohen, Psy.D. President catherinecohen@hotmail.com Robin Zasio, Psy.D. Past President & MCeP Chair DrRobin@sierrabg.com Catherine Broomand, Ph.D. MeMbershiP Chair cbroomand@hotmail.com Rob Woodman, Ph.D. CPa Liason rwoodman@sbcglobal.net Paul Mattiuzi, Ph.D. teChnoLogy Chair Ma2z@surewest.net Marla McMahon, Psy.D. seCreatry memahonpsy@earthlink.net Rory Osborne, Ph.D. disaster resPonse Chair Laurie Wiggen, Psy.D. newsLetter ChairPerson drwiggen@gmail.com Melissa Holland, Ph.D. MeMber at Large Mlhmail@aol.com James Cooper, Ph.D. MeMber at Large coopphd@earthlink.net Jill Landerholm, Ph.D. MeMber-at-Large Jennifer Houser, M.A. student Liason The Sacramento Valley Psychological Association Forensic Division Board Christopher Heard, Ph.D. President chdocgrampa@aol.com Honors our Past Presidents You are Invited: Come enjoy an evening of reminiscing and celebration with your SVPA Colleagues, old and new. Hors d’oeuvres and Libation in plenty! Eugene Roeder, Ph.D. Past President eproeder@sbcglobal.net Kathryn Jaeger, Ph.D. treasurer/seCretary kljaeger@sbcglobal.net Jeffrey Miller, Ph.D. MeMber-at-Large 916-366-9265 November 10, 2006 • 6:30-8:30 pm At the home of Dr. James and Betty Cooper Your Hosts: Catherine Cohen, Psy.D., SVPA President James Cooper, Ph.D., SVPA Board Member Cynthia Newman, Ph.D., SVPA Past President Irving Hellman, Ph.D., SVPA Past President Lisa Perrine, Ph.D. MeMber-at-Large lperrinephd@sbcglobal.net Irving Hellman, Ph.D. MeMber-at-Large idhellman@aol.com Cynthia Neuman, Ph.D. ChiLd Custody Liason cneumanphd@sbcglobal.net Kindly RSVP to Catherine Cohen (916) 444-8834 • catherinecohen@hotmail.com Anita Milliken board seCretary Anita_Forensicbd@sbcglobal.net 2 The SACRAMENTO VALLEY PSYCHOLOGIST Fall 2006 Become A Red Cross Volunteer T By Betty Sutton, Ph.D. he country recently remembered assistance. There is a great need for the anniversary of Hurricane more psychologist volunteers. The APA works with the ARC to Katrina. I remembered watching the events on TV wishing that I could do develop and coordinate training and volsomething. I received an Email from unteering. CPA has a statewide DisasAPA asking for volunteers to go to ter Response Network (DRN) and a the devastated areas as mental health chair of that network. In addition, many local CPA chapters have a volunteers for the American DRN chair. I have recentRed Cross (ARC). I faxed ly been appointed by the my application and took a There is a SVPA Board as the Chair training class at the local great need of the Sacramento Sierra ARC chapter. Four days for more ARC Psychology DRN. The later I was in Baton Rouge being oriented for service psychologist CPA DRN chair recently developed a database so that near New Orleans. I spent volunteers. when volunteers are needed, 12 days providing emergenthey can easily be contacted. cy mental health services to More information about the survivors, police officers, and ARC staff. The greatest challenge national network can be found at http:// was that there was so much that needed www.apa.org/practice/drnguide.html. Folto be done and so few volunteers. There lowing are several quotes from the APA were only 2 of us at the Kenner Police website: “The DRN was created to proStation, myself and a graduate student. We were providing services to about vide immediate, short-term and cri10,000 residents and staff. I knew we sis intervention services to individuneeded help, but either there were not als, organizations and communities in enough volunteers or the ones who need following a traumatic event. It is came could not cope with the devasta- composed of volunteer psychologists tion or the grueling conditions. Since I whose DRN activities are provided on returned home, I have been working to a pro bono basis. The Disaster Response Network recruit more volunteers. Many of the Katrina mental health volunteers were (DRN) of the American Psychological MA level clinicians who really did Association (APA) is the mechanism not have the skills to provide effective through which volunteer psychologists respond to local and national disasters and other traumatic events. Since the launch of the DRN as APA’s centennial gift to the nation in 1992, over 3,000 psychologists have volunteered their professional skills to individuals, families and communities. DRN members have responded to disasters as diverse as the Oklahoma City bombing, Hurricane Andrew, and the Northridge earthquake.” In addition to the DRN, there are local Disaster Action Teams (DAT) that respond to local disasters such as fires, floods, earthquakes, accidents, etc. For example, in the recent plane accident in Lexington, I received a call since one of the passengers had family in Sacramento. The ARC provides immediate motel rooms and emergency supplies along with mental health first aid to families who are victims of fires. In the Sacramento area there is currently only one other psychologist beside myself who is a volunteer. We need more. If you can spare the time, please become a volunteer. To qualify as a volunteer, you must hold a valid license and be in good health. There are certain required courses that you must take. These include: CPR, First Aid, Introduction to Disaster Services, and Fundamentals of Disaster Mental Continued on page 7 Consultation/Study Group in Contemporary Psychoanalytic Psychotherapy, facilitated by Susan Boulware, PhD, (CE provider #3657). Didactic and clinical components. 916.492.9442  The SACRAMENTO VALLEY PSYCHOLOGIST Fall 2006 For info, call Insomnia or Sleep Disorder from page 1 1) occasional—few nights per month (affecting 21% of those with insomnia), 2) common—few nights per week (affecting 23% of those with insomnia), 3) always—almost every night (affecting 35% of those with insomnia, and 4) rare or never—does not follow any pattern (affecting 21% of those with insomnia). Of all of the causes listed for the new temporal patterns (formerly secondary insomnia) of sleep disorder perhaps insomnia caused by a poor sleep environment is the easiest to deal with and can be best helped by introducing cognitive behavioral approaches coupled with instruction on sleep hygiene. Though generally speaking sleep hygiene techniques cannot work unless accompanied with some behavioral therapy and/or pharmacological measure. I have listed three excellent web sites at the end of this article that also address sleep disorders and sleep hygiene. Also appearing at the end of this article are two tables (Tables 4 and 5) which provide more detail and comments about causes of both transient and chronic insomnia. Despite all the causes that appear in these tables aging remains the most common cause of chronic insomnia. In all cases of insomnia the sleep that the individual does receive is considered to be poor and non-refreshing. Interestingly between 9-12% of the population is bothered from time to time by insomnia and of these people, 90% are known to suffer chronic problems. Unfortunately 20% of the suffers of insomnia also have daytime functioning problems usually manifested by a significant reduction in either or both mental acuity or physical performance. Quality of life studies have shown that those with insomnia are compared to normals they are more likely to: be admitted to the hospital, have a lower tolerance to pain, suffer more accidents,  and take more days off from work. Now that we have a somewhat better understanding of the causes and types of insomnia, let us review the recognized forms of treatment available to US consumers. There are both pharmacological and non-pharmacological treatments aimed at helping those who suffer from insomnia. Pharmacological treatments for insomnia include over-the-counter (OTC) products or non-prescription options and agents available by prescription only. OTC Options Over-the-counter options include alcoholic beverages that, if used just before bedtime can reduce sleep latency; however, large amounts of alcohol can result in a poorer quality of sleep with increased awakening at night. Other OTC products include antihistamines; yet, tolerance is know to develop with these products and daytime hangover is not uncommon. Other concerns with the use of antihistamines include cognitive impairment and delirium, the latter being of concern in the elderly. Herbs may also be used with valerian root being very popular throughout the European countries. Data does exist to suggest that valerian works at the benzodiazepine receptor site. People who abruptly stop this agent may experience benzodiazepine withdrawal symptoms. Finally there is some risk of hepatic damage with valerian root products. Melatonin is another OTC option that has been shown to help with jet lag induced insomnia. This product is generally well tolerated. Its primary use is as an aid for those that have trouble falling asleep; therefore, the product should be taken in the early evening. Melatonin is not for people with chronic insomnia. However, a newer prescription medication that impacts specific melatonin receptors has recently been approved for the management of sleep-onset insomnia. This agent will be discussed when we The SACRAMENTO VALLEY PSYCHOLOGIST Fall 2006 discuss prescription pharmacological treatments below. Prescription Pharmacological Treatments There are 5 benzodiazepines that have been approved by the FDA for sleep disorders. Only 4 have been listed in Table 1, as these four agents are the most commonly prescribed benzodiazepines used for sleep. The last agent listed in the table, flurazepam has faded out of use due to its long half life and active metabolite that also has a long half-life. The benzodiazepines all work by non-selectively impacting the GABA-A receptors. Not only do these products offer sedative action, they also offer antianxiety effects, anticonvulsant action and hypnotic action. Yet, despite this rich pharmacological profile, the benzodiazepines do bring some problems with them owing to their non-selective GABA-A receptor affinity. First, we can see a decrease in daytime cognitive functioning due to drug carry over into the next day. This problem is not an issue when these products are used sporadically. It does become a problem when these agents are used on a daily basis for long periods of time. And this problem is more pronounced in the elderly. The sedation also can lead to decreased motor functioning skills both in the daytime and nighttime and this has been reported to be one of the leading cause of falls in the elderly. Interestingly a recent study has shown that the problem of insomnia is a greater cause of falls in the elderly simply because people with insomnia have balance problems. There was also some serious structural flaws in the earlier study that linked the use of benzodiazepines to falls in the elderly. Memory loss is another problem seen with the use of the benzodiazepines. People can develop a tolerance to the benzodiazepines hypnotic effects; though this author has seen certain geriatric patients who have taken a benzodiazepine at bedtime for years with no ill consequences while the product did aid their getting to sleep. The benzodiazepines have also, in very rare cases, caused amnesic states in people as demonstrated by these people waking up across town after driving there with no recollection of how they got there. Finally, there are also problems with both physical and psychological dependence, though the former is rare when one considers the total number of people who have been exposed to the benzodiazepines since there discovery over 40 years ago—conservative estimates are approximately 700 million people. (See Table 1) Another line of pharmacological treatment is the non-benzodiazepine hypnotics or as they are known in the field—the Z compounds. These Z compounds are: • Zopiclone (Imovane) only in Canada or some other countries • Zolpidem (Ambien) • Zaleplon (Sonata) • esZopiclone (Lunesta)—this one is indicated for chronic insomnia and may be used for periods in excess of one month A comparison table follows to assist the reader to understand the slight variation found in the Z hypnotics. (See Table 2) Without belaboring the point the Z hypnotics are better for the management of insomnia because on the whole this class of medication does not routinely suppress REM sleep nor do these agents disrupt sleep architecture. I have added still another table, Table 3 below that compares the benzodiazepines and the Z-hypnotics and the reader can use this comparison chart to aid in their understanding of the two classes of agents used in the management of insomnia. (See Table 3) Table 1 Traditional Hypnotics Agent Triazolam (Halcion) Temazepam (Restoril) Lorazepam (Ativan) Flurazepam (Dalmane) Dose (mg) 0.125-0.5 7.5-30 0.5-2.0mg 15-20 Onset (minutes) 20-30 60-120 20-40 30-60 Half-life (hours) Metabolite 2-3 8-20 4-6 3-8 40-120 Duration (hours) 2-5 6-10 6-8 10+ “hangover” Table 2 Comparison of “Z” Hypnotics available in USA Z-hypnotic Zaleplon (Sonata Zolpidem (Ambien) Zolpidem CR (Ambien CR) Eszopiclone (Lunesta) Usual dose (mg) 5-10 5-10 6.25-12.5 1-3 Onset (minutes) 30 30 30 45 Half-life (hours) 1.1 2.5 2.8 6 Duration (hours) 2-4 4-6 4-6 5-8 Table 3 Clinical Comparison of Benzodiazepine Receptor-active agents Benzodiazepines non-selective Anxiolytic muscle relaxant anticonvulsant suppresses REM decrease slow-wave sleep abuse potential CNS side effects Z-hypnotics alpha 1 selective not anxiolytic not a muscle relaxant not an anticonvulsant no significant impact minimal or no impact on REM or slow wave less abuse potential CNS Side effects Food will decrease the absorption of the Z hypnotics; therefore, these products should be taken on an empty stomach or if patients do need these agents to aid their sleep they should be advised to not eat a heavy or high-fat meal. Those these agents are all similar each has its own unique profile. The scope of this article does not allow me to give details on each agent; however, I will make three brief comments about these agents. Eszopiclone (Lunesta) has been approved for long term use in chronic insomnia while the other Z-hypnotics have not. There is even data that supports both the safety and efficacy of this product when use for more than a year continuously. Next, despite manufacturer’s claims, there does not appear to be any benefit to the CR form 5 The SACRAMENTO VALLEY PSYCHOLOGIST Fall 2006 of Ambien and patients would be better advised to use the less expensive form of this product. Lastly, there have been recent reports in the lay and professional literature that certain individuals can suffer a side effect of amnesic food binges, late at night. There has even been some anecdotal reports of Z-hypnotic users finding their refrigerators empty the next morning. There are also a few agents in clinical trials that have promise and we will make a few comments about these agents: • Indiplon—an GABA alpha 1 selective agent with a very short half life • Gaboxadol—this is a GABA-A agonist that seems to increase slowwave sleep, which is that deep, restorative sleep Continued on page 6 Insomnia or Sleep Disorder from page 5 Trade names have not been assigned to either of these agents as of September 2006. Lastly let us look at Rozerem or ramelteon that is a new hypnotic agent designed to aid sleep-onset insomnia. This product is a melatonin receptor agonist and must be taken 30 minutes before the patient’s desired sleep time. The agent has no abuse potential, though food does slow absorption, so like the Z-hypnotics this product should not be taken after heavy or high fat meals. The important bit here is that this product is only approved for sleeponset insomnia and not the other forms mentioned above. We have not mentioned other agents, e.g. trazodone that are also used in the treatment of insomnia and sleep disorders as these agents are not specifically designed pharmacologically as hypnotics. Non-pharmacological approaches According to the NIH consensus statement mentioned at the first of this article, pharmacological agents are the most common form of treatment used in the intervention of insomnia. Even though medication use is com- mon we do have the results of a number of randomized double-blind, placebo controlled behavioral clinical trials that have compared medications and cognitive behavioral therapy (CBT) and concluded that the latter is at least as effective as medication alone for treating chronic insomnia. In fact, the non-elderly with sleeponset insomnia can derive significant more benefit from cognitive behavioral therapy than pharmacotherapy. Thus increased recognition of the value and efficacy of cognitive behavioral therapy and wider recommendations for its use could improve the quality of life of large numbers of patients with insomnia. Interestingly the results of CBT are longer lasting than pharmacological approaches. So why is medication the first choice? Medications do work faster and the medication is a good idea while nonpharmacological (CBT) is being implemented for the results of CBT might not be evident for up to 6-8 weeks or more. Conclusion In the preceding article we have attempted to provide the reader with a working definition of insomnia, outline the classification system for insomnia and provide some information related to the various forms of treatment, both pharmacological and non-pharmacological, that have shown efficacy in the management of insomnia. Material that appeared in this article has been abstracted from numerous publications and a comprehensive reference list is available upon request. In our next column we will discuss the pharmacological management of ADHD. Readers are always encouraged to submit comments or questions directly to the author at fraleigh44@gmail.com Web sites of value for sleep disorders and sleep hygiene: http://www.thesleepsite.com/hygiene.html (accessed 9-06) http://www.webmd.com/content/article/62/71839.htm (accessed 9-06) http://www.umm.edu/sleep/sleep_hyg.html (accessed 9-06) http://www.nhlbi.nih.gov/health/public/sleep/insomnia.htm (accessed 9-06) http://www.emedicinehealth.com/insomnia/article_em.htm (accessed 9-06) http://www.talkaboutsleep.com/sleep-disorders/2005/06/insomnia-nih-statement.htm (accessed 9-06) Body Dysmorphic Disorder The Difficulties Encountered in Diagnosis and Treatment Robin Zasio, Psy.D., LCSW, Presenter This workshop will discuss the complexities of the diagnostic process when evaluating for Body Dysmorphic Disorder and differential diagnoses. The workshop will help participants to recognize symptoms through direct questioning, and learn how exposure and response prevention therapy is used as the most effective treatment modality. A case presentation will illustrate the diagnostic and treatment process. 6 The SACRAMENTO VALLEY PSYCHOLOGIST October 16 SVPA’s Dinner Meeting Dr. Robin Zasio is the Owner and Director of The Anxiety Treatment Center located in Sacramento. She specializes in Cognitive Behavioral Therapy utilizing Exposure and Response Prevention Therapy. In her practice she provides individual, group and family therapy services, as well as a daily Intensive Treatment Program. Dr. Zasio has been the President of the Sacramento Valley Psychological Association for the past three years. Currently she serves on the board as Past President and MCEP Chair. Dr. Zasio serves on the advisory board of the Sacramento Chapter of the National Alliance of the Mentally Ill. She is a member of the Obsessive Compulsive Disorder Foundation, California Psychological Association, and American Psychological association. Fall 2006 Table 4 Causes of Transient Insomnia Cause Response to change or stress Jet Lag Comments 34% of women and 22% of men interviewed reported stress impacted their sleep Traveling west seems to be easier to handle, east bound travel may take a 1 day adjustment for each time zone crossed 53% of night shift workers fall asleep on the job at least once a week. These people also have more accidents. A Japanese study reported that heavy use of computers was associated with all forms of insomnia Substance use or abuse accounts for 10%-15% of all chronic insomnia cases 17% of the women and 5% of the men reported that their sleep partner’s snoring caused sleep problems. Of 40% of the men and women self reporting snoring close to 20% of these people’s snoring could be heard through closed doors. Many medications can cause insomnia 20% of all adults reported that some environmental factor interfered with proper sleep Work Conditions Caffeine, alcohol and other substances Partner’s sleep habits Medications Environmental Factors Table 5 Causes of Chronic Insomnia Cause Medical Conditions Comments 22% of adults surveyed with health problems report sleep difficulties. Sometimes the medications used to treat the condition also add to the insomnia. A large percentage of chronic insomnia cases prove to have a serious psychological issue. Dropping levels of progesterone can lead to sleep disorders. Normal aging can blunt growth hormone known to aid sleep. Some people has delayed circadian cycles Seen more in the elderly and can also be seen with leg cramps. Sleep problems between identical twins are more likely connected vs. fraternal twins indicating a possible genetic link. One study suggested that a child reared without a routine “bedtime” is more likely to have intermittent insomnia. The study did not look as issues like marital discord or other environmental factors. Misuse of drugs, chronic stress are just a few examples. Volunteer from page 3 Emotional Disorders Hormonal fluctuations in women Hormonal changes during aging Delayed Sleep Phase Problems Nightly Leg Problems “Restless Leg Syndrome” Genetic Factors Childhood Insomnia Behavioral Factors Tables 4 and 5 have been modified slightly from: “A guidebook to Insomnia” that can be found at: http://www.chs.edu.sg/gep/insomnia/causes.html (accessed 9-06) Though this site has not been updated since 2002 and therefore does not have the latest consensus information reported in the start of this article.   The SACRAMENTO VALLEY PSYCHOLOGIST Fall 2006 Health. These classes are offered by the Red Cross, and most are free for volunteers. The Disaster Mental Health course was recently revised in collaboration with the APA and is now 1-day. Volunteers take this for free and are given 6.5 hours of CE credit. (This class is required by some managed care insurers to do crisis intervention.) To get additional information on how to become a volunteer visit the local ARC’s website: http://arcsacramento.axxiomportal.com/. You may also call the local chapter at (916) 368-3130. They are located at 8928 Volunteer Lane, near Watt and Folsom. I would be happy to talk to you about what mental health volunteers do. You can reach me (916) 939-0118 or bjsutton@sbcglobal.net. This was an event that changed my life forever. I encourage you to become a volunteer.  Who or What is CLASP? C LASP is the Colleague Assistance & Support Program for Psychologists. The primary goal of the CLASP Program is to assist psychologists in reaching out for support anywhere along the continuum from wellness to crisis. Participation in the CLASP program offers chapters and psychologists the chance to encourage and enhance self-care in ways that can significantly contribute to the well being of you and your colleagues. There are multiple dimensions to CLASP. We offer an Information and Referral Service which is monitored by the CPA CLASP Committee. The toll free number (888-262-8293) is confidential and is a resource to any psychologist or doctoral level psychology student who may be seeking a referral for therapy, consultation, workshops, information on self care, or to get support around a colleague. It is free to join. Once you become a provider, you have the opportunity to receive referrals in your practice, with the client or consultee being a psychologist. Once you receive the referral, you would work within your own policies and procedures, fee structure, and limits of confidentiality. We also offer workshops on wellness, self care, resiliency, and burn out for psychologists, publish articles in the CP on topics related to colleagues support and enhancement and we are developing materials for chapters and psychologists on these topics. Consultation groups, workshops, and activities will also be developed. We are actively recruiting providers for our CLASP I&R Service as well as Chapter Representatives. We also have 3 openings on the CPA executive committee. If you are interested in being part of CLASP in any way, it would be great to have you join us. Please share the word with others. We are working to destigmatize help seeking behavior and take a preventive stance to our work and encourage psychologists to reach out for support anywhere along the continuum from wellness to crisis. If you have any additional questions, please feel free to contact me at either 831-426-4735 or dani_beckerman@yahoo.com; and check out our website at http://www.cpaclap.org. Dani Beckerman, Psy.D. CPA CLASP Chair  CPA’s Colleagues Assistance and Support Program (CLASP) CLASP is committed to preventive resources that will support us as professionals in maintaining and enhancing our general health and mental well – being through out the developmental spectrum of our personal and professional lives. • Call CPA’s CLASP confidential I & R Line (888-262-8293) for materials on self care and resiliency, educational programs, and information. Referral to a psychologist or community resource available upon request. This service is available to all California psychologists. • Check out our website for additional resources ~ http://www.cpaclasp.org • Join our I & R (no fee) and become a provider to work with other psychologists. CPA CLASP Chair: Dani Beckerman dani_beckerman@yahoo.com or 831-426-4735  The SACRAMENTO VALLEY PSYCHOLOGIST Fall 2006 Meet Dr. Jill Landerholm has recently joined the Board of Directors of SVPA in order to contribute to developing SVPA as a supportive community for the region’s psychologists. This month we are highlighting her work so that the community may get to know her better. Dr. Landerholm, please tell us about your practice. I am a Clinical Psychologist with a private practice specializing in adult individual and couple’s psychotherapy, drawing upon more than 17 years of clinical experience. In my work, I most enjoy working with clients to transform their deepest experiences of themselves and others in a way that helps them respond more effectively to life’s challenges and attain greater satisfaction in their lives. I my private practice, my broad therapeutic background allows me to assist a wide range of clients with approaches that are specifically suited to their concerns. In general, I work with clients who seek therapy to resolve personal and relationship challenges such as resolving trauma, depression, anxiety, or bereavement; transcending past emotional injuries and old relationship patterns; healing trust and love issues; responding to sexual, reproductive and life transition issues; and coping with serious illness or disability. I also have a special interest in trauma resolution, dating back to my dissertation topic of factors that foster interpersonal resiliency following sexual abuse or assault; I continue to develop my understanding of trauma recovery by staying up to date on evolving theoretical views and newer treatment approaches, such as EMDR. What therapeutic approaches do you use? My approach to treatment is highly integrative in an effort to attune my interventions to the specific resources and challenges of each client. My general theoretical framework is depth-based, predominantly stemming from developmental and psychodynamic approaches. When appropriate within this psychodynamic context, I may also use EMDR or expressive therapy interventions to facilitate adaptive resolution of distressing experiences. Even many of my clients who have previously developed great insight into their own dynamics have found that these interventions powerfully assist them to translate this understanding more directly into new behaviors, internal resources, and ways of relating to others. In other cases, such as in treating panic disorder or phobias, I find that cognitive-behavioral approaches are most effective in generating rapid and lasting recovery for clients. In my work with couples, I seek to repair disruptions and facilitate a deepening of the couple’s attachments to each other; I often use an emotionally-focused couple’s therapy approach, which honors the psychodynamic framework while making use of the power of the couple’s attachment to each other to effect change for the individuals individually and in their relationship.  The SACRAMENTO VALLEY PSYCHOLOGIST Fall 2006 Jill Landerholm, Ph.D. Tell us more about your background. I trained at Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, in Houston, Texas, and received my Clinical Psychology doctorate at the University of Texas at Austin. Early in my career, I knew that I ultimately wanted to practice privately, so I sought experiences that could support me in working effectively with the wide range of issues that might arise in a general practice setting. I have experience in providing psychotherapy to individuals of all ages and diverse backgrounds, in individual, couple, family, and group modalities. I have treated clients in a variety of outpatient, inpatient, and forensic settings. I have substantial experience in diagnostic, neuropsychological, and forensic assessment. My experience also includes consultation, supervision, and training of other clinicians. Prior to my psychological training, I completed my undergraduate degree at Mills College in Oakland, and Master’s-level work at Stanford University in Palo Alto, both in the field of computer science. I worked as a software engineer at a major computer company for several years before discovering my calling as a psychotherapist, which I feel added greatly to my breadth of life experiences. I have spent much of my life in California, and the past seven years in the Sacramento area. I enjoy networking with colleagues and look forward to contributing to the SVPA community. Dr. Landerholm, how can you be contacted? I can be contacted by phone at (916) 599-3004, or by email at: jlanderholm@vayamentalhealth.com My office is located on University Avenue in Sacramento near Highway 50, Howe Avenue, and Sacramento State University. The address is 945 University Ave., Suite 100, Sacramento, CA 95825.  BOOK REVIEW by Richard Restak, M.D. 2003 Fantastic and exciting book about the newest discoveries in brain research. Dramatic findings and technologies are presented, and implications for future applications are downright overwhelming. (OK, I get into this stuff!) From forensics (can brain scans serve as lie detectors; and could our brain ‘profile’ be a better identification than fingerprints?) to health implications (can bypassing the retina and sending signals directly to the brain enable a blind person to see?), the possible ways we will use these findings are diverse. They raise questions about what we value and how we define personal responsibility. The New Brain Legislation Signed Into Law From Capitol Notes AB 733 (Nation) Duty to Warn SIGNED INTO LAW AB 733 (Nation) was signed into law by the Governor last week. The bill will become law on January 1, 2007. From its initial form, the bill was narrowed to deal with the issue of the Judicial Council instructions given to juries in cases where the duty to warn is invoked (or not invoked), such as Ewing v. Goldstein. Current Judicial Council instructions state that a therapist has to BOTH notify the intended victim and the law enforcement in order to receive immunity. This is contrary to the Civil Code which reads that the therapist must make reasonable attempts to contact the intended victim and law enforcement. The current duty can also be discharged by hospitalizing a patient, for example. AB 2257 (Assembly Committee on Business and Professions) SIGNED INTO LAW The CPA Government Affairs Staff is pleased to announce the signing of the CPA-sponsored record retention bill. AB 2257 (Assembly Committee on Business & Professions), was signed by Governor Arnold Schwarzenegger on July 20, 2006. Beginning January 1, 2007, all licensed psychologists must retain a patient’s health service records for a minimum of seven years from the patient’s discharge date or seven years after the patient reaches the age of majority (18 years old). Prior to the passage and signing of AB 2257, state law did not address the issue of record retention by psychologists in independent practices. CPA introduced this legislation in response to frequent and continuing comments from California psychologists regarding what Continued on page 12 Here are the chapter titles to tempt you to read this highly recommended book: 1. Brain plasticity—Your Brain Changes Every Day 2. Genius and superior performance: Are We All Capable? 3. Attention Deficit: The Brain Syndrome of Our Era 4. More Images Than Ever: Is It Destabilizing Our Brains? 5. The Happy Brain: The Joy and Music in You 6. Modern Imaging Techniques: Windows on the Mind 7. Cosmetic Psychopharmacology 8. Healing the Diseased Brain: New Attempts at Brain Repair 9. The New Brain  Hello to All That: A Memoir of War, Zoloft, and Peace by John Falk 2005 I loved this book. Read it and you will learn about the reality of living in the nightmare of sniper infested Sarajevo as well as living in the nightmare of the hopelessness and deadness of clinical depression. John Falk shows how depression can strike out of the blue (with a family history providing the genetic vulnerability)and how someone can hide it and no one around him realizes how suicidally depressed he is. Looking for anything to make him feel alive, he develops a wild and crazy persona at college and later fakes his way into a foreign correspondent role. There are two parallel sets of stories here - one involving his relationship with the families he met in Sarajevo, his interviews with a top anti-sniper, and his rather amazing success in getting three Sarajevo students to the US on full scholarships. 0 The other involves his childhood, his sudden and chilling onset of depression and his eventual profound and sudden reprieve the day his Zoloft kicks in. Falk always thought “Prozac is for losers” (and in fact, for him, Prozac his first try at medication - made things worse). He simply didn’t get it that clinical depression is a medical disorder, not a character flaw. This is a graphic, realistic description of the experience of depression and taking anti-depressants. One of the best I’ve encountered.  The SACRAMENTO VALLEY PSYCHOLOGIST Fall 2006 President’s Address by Catherine Cohen, Psy.D. A few more Noteworthy mentions: We like to eat! Well, yes–who wouldn’t love a delicious meal at the Lemon Grass Restaurant in the company of colleagues who are getting CE units while listening to interesting talks by local professionals? SVPA has enjoyed a successful first season of Dinner meetings, and will wrap up the year with Dr. Robin Zasio’s discussion of Body Dysmorphic Disorder on October 16. Besides, if you stay late for the SVPA Board meeting afterwards, you might get to take home the leftovers which make a convenient next day lunch. Thank you again Dr. Debra Moore, and Dr. Zasio for your presentations. The board is already discussing topics and speakers for next year’s meetings. They will likely include neuropsychology, medications, legal issues, and specific areas of clinical technique. If you have an interest or wish to present, please contact me. Improved Email Lists Dr. Catherine Broomand, Membership Chair, has completed SVPA’s updated email roster. This will help us reach you when we can’t call personally. Stay tuned! Dr. Betty Sutton Joins Us As Disaster Response Chair Dr. Sutton’s years of experience and expertise with governmental agencies makes her an exemplary chairperson and SVPA board member. Having assisted with the Katrina aftermath, Dr. Sutton understands psychology at the front-lines. SVPA is pleased to support her outreach and training efforts. Dr. Rob Woodman, CPA Liason is responsible for our great CPA updates. Get to know him better in this issue of The Sacramento Psychologist. And Finally, The Board—Thank you SVPA board for exemplary teamwork!  November 10 Past President’s Celebration SVPA’s roots stretch back to the 1960s! Dr. Cynthia Newman, Dr. Irving Hellman, Dr. James Cooper and myself are co-sponsors and the SVPA Board is hosting. See this newsletter (page 2) for more information and to RSVP. December 8, 7 pm. SVPA Annual Holiday Party Save the Date. Mentorship Program Forming Thanks to the diligence and hard work of our Student Liason, Jennifer Houser-Ruff, M.A. (who is also writing her dissertation!), SVPA is able to offer this fascinating new program. Jennifer is also responsible for the development and creation of a student outreach brochure. Not bad for an organization that doesn’t even have official letterhead! Mentor was a real (mythical) guy! When Odysseus went to war, he entrusted Mentor with his son’s education and development. Mentor’s wise counsel, teaching, concern and protection were his legacy, and the concept has been carrier from ancient classical times to current post-911 times. But…do you need to don your toga and take a seat in the forum to become a mentor?  The SACRAMENTO VALLEY PSYCHOLOGIST Fall 2006 CPA Liaison Report Rob Woodman, Ph.D. Reporting T he California Psychological Association has added some real value to membership, especially for those of us in private practice. We can now get group rates for Dental, Vision, Disability, Cancer, and Accident Insurance. We can also get reduced rates for House and car insurance. Officers of SVPA should be members of CPA so that they can be covered by the CPA errors and omissions liability insurance. There are reduced membership rates for early career psychologists, first time members and students. Matthew Yeates is the new Grassroots and PAC Manager/Legislative Analyst. He has experience, he is knows what he is doing, he is on top of things and he is collaborative and responsive. Matt is a very valuable addition to our lobbying team, along with Amanda Levy, and I am sure that he will serve us well. CPA has had some good legislative success this year. The most important thing is that we were able to keep the Board of Psychology and not be subsumed under a board for master’s level practitioners. However, this is only a two year reprieve and we will need to address this issue again. Our bill, AB2257 requires that psychologists keep patient records for 7 years after date of discharge or after turning 18. The Duty to Warn was clarified. We were also able to defeat the Licensed Professional Counselor bill that would allow people with a master’s degree in psychology or a related subject to practice with no limit to the scope of practice. This bill will return this year but with experience and a lot of money behind them. In order to protect the public and the integrity of our profession, we need to defeat this bill again. The long awaited new CPA website will go live within the next few weeks. 2 It will much easier to navigate and will offer a lot more services. Your login to get into the members only part of the site is on the mailing label of California Psychologist. Be sure to visit the site in the next few weeks. Members will probably get an email from CPA announcing the new site. There are online ways to keep up with things that are going on: Capitol Notes is a membership benefit of the California Psychological Association, sent to members on a regular basis when the State Legislature is in session in Sacramento. If you are not receiving this newsletter directly, and you are a CPA Member and would like to, please email alevy@ calpsychlink.org with the message Add me to Capitol Notes in the Subject line. PROGRESS NOTES keeps up with what is going on in psychology. To sign up a colleague for a free four month subscription to PROGRESS NOTES, send an email to Annie DeMaria Norris at: adnorris@CalPsychlink.org and ask for the free subscription to PROGRESS NOTES. The email should include the name of the CPA member who referred the new subscriber and the new subscriber’s name and preferred email address. You can use my name, Rob Woodman, as the referring person. CPA also has a discussion list serve for members that turns out to be very useful. People ask questions of colleagues, requests for referrals and other things. CPA elections are coming up. Be sure to vote when it comes. The next CPA Board Meeting is October 20 & 21. If you have anything that needs to be brought to the board, please contact me at Dr_Woodman @ sbcglobal,net  Legislation Signed Into Law from page 10 were ambiguous and inconsistent private practice record retention requirements. Confusion regarding the length of time a practitioner must retain health records jeopardizes both the psychologists and patients alike. AB 2257’s seven-year retention requirement represents a minimum requirement for the length of time psychologists must retain mental health records. Private practitioners are allowed to retain their records for a longer period, if they wish. AB 2257’s requirement is consistent with current practice for California’s heath facilities, such as licensed clinics, nursing facilities, adult day health care facilities, intermediate care facilities, and skilled nursing homes. Florida, New Jersey, and Oregon have equivalent record retention requirements of seven years minimum from last appointment or date of service. Texas has the longest retention of records with a minimum of ten years and an additional ten years after the patient turns eighteen. This bill passed the Legislature without a single NO vote and was then promptly signed by the Governor.  The SACRAMENTO VALLEY PSYCHOLOGIST Fall 2006 SVPA is now forming a Student and Early Career Mentorship Program! As we all know, research clearly indicates that students and young professionals (young in the field too) who have been mentored are “more satisfied and committed to their professions than the un-mentored”, (2006, Introduction to Mentoring; a guide for Mentors and Mentees. Presidential Task Force, American Psychological Association). If you think back, you likely recall several clinicians who served as mentors to you although formal mentorship programs were not yet popular. Now that you have collected years of experience as a Psychologist, SVPA calls upon your wisdom. Think you don’t have time? How about 1-2 hours a month by email? Think you aren’t wise enough? You became an SVPA member didn’t you?! Think you’ll be the only one giving? Think again! Learn more about mentoring—what it is and what it is not. For anxious, bullied/rejected, or socially unskilled clients. Girl’s group, ages 9-12 (1 opening) Late teen/young adult men’s group (2 openings) Late teen/young adult women’s group (1opening) SOCIAL SKILLS GROUPS Our current openings include: For more information, please call Debra Moore, Ph.D. at www.sacramentopsychology.com  The SACRAMENTO VALLEY PSYCHOLOGIST Fall 2006 (916) 344-0900 It’s That Time Again! Please take a moment to renew your membership with SVPA. The price of membership includes a year of listing your website profile and online updates on the latest news from the SVPA as well as discounted rates for CEU’s and Dinner Meetings. Please complete the information below and send this, along with your check (made out to SVPA) for $60.00 to: SVPA c/o Catherine Broomand, PhD. • 7230 S. Land Park Drive, #103 • Sacramento, CA 95831 Name:_ _____________________________________________________________________________________________ Degree:_ ____________________________________________________________________________________________ Address:_ ___________________________________________________________________________________________ _ City:________________________________________________________ State:__________ Zip:______________________ Lic._No.:________________________________________________________________ _ Phone:_(______)_________________________________________________________ E-mail_address:_ _________________________________________________________ ✁ The Sacramento Valley Psychological Association  The SACRAMENTO VALLEY PSYCHOLOGIST Fall 2006