Workshop coming up in April!

1.5 CEUs available

For reservation information, cost, location, and time, see below.

+++++++++ And Next Month +++++++++

April 15, 2011

The Tender Loving Care and Feeding of the Brain:
Current evidence based research incorporating health habits, therapy techniques, psychopharmacology and spirituality in caring for our clients with mental health issues

Presented by: Satu Woodland, PMHNP

In this very practical presentation, I will discuss my practice as a psychiatric mental health nurse practitioner and what I have learned in my 25 years of research/practice in the areas of mental health. I will discuss medical conditions/deficiencies that can create mental health symptoms that are often missed, when to refer for psychopharmacology, why we must be concerned about our clients health habits, key elements of psychotherapy that must be present in any psychotherapeutic relationship, and why it is important to engage the patient’s own spiritual belief systems in providing care. Clinicians will be able to incorporate this information into their own practices and know when to refer out for help with their clients where there is a deficit in knowledge or practice parameters.

Learning objectives:

1) Recognize possible medical conditions that could be contributing to a client’s mental health issues.

2) Understand when referral for psychopharmacology is warranted.

3) Become familiar with current research in health habits that a client needs to be aware of for good mental health.

4) Introduce some current research regarding which therapies work for which types of problems.

5) Identify reasons of why and how to engage a client’s spiritual belief system in his care.

Satu H. Woodland PMHNP is a psychiatric mental health nurse practitioner in private practice in Bend. She has been working in the medical and mental health fields working with adults, teens and children since 1984. She has practiced mostly in the San Francisco Bay Area, California in various in-patient and out-patient settings with the last 5 years in private practice in Bend. Undergraduate work at Brigham Young University and California State University Dominguez Hills. Graduate school at University of California San Francisco. Married for 29 years to local mortgage broker David Woodland, mother of 5 highly productive children and 1 grandchild (with one on the way!), she has extensive practical experience working with children and families. For more information, please visit her website at

1.5 CEUs available pending approval

RESERVATIONS: to D’Arcy Swanson: or 419-3947 by Wednesday, two days before the Luncheon. Reservations made after Wednesday will be charged an additional $5. Specify vegetarian meal if desired. 24-hour notice of cancellation is required or you will be charged for your lunch. Visit our website for the latest news, questions and events at

These luncheons are held the third Friday of the month, September through June, at Touchmark from 12:00 Noon to 2:15 PM
Cost (includes lunch): $15.00 members; $20.00 non-members; CEU’s add $10 (if available);

Touchmark is at 19800 SW Touchmark Way in Bend. It is on the west side of the Bill Healy Memorial Bridge, just south of the roundabout at Reed Market Road and Mt. Bachelor Drive, and very near the Athletic Club of Bend. Click here for a detailed, interactive map: Touchmark Bend


Psychiatric adanced practice nurses as alternatives to psychiatrists

I read with interest the article written by Gardiner Harris on the Sunday, March 6th of the Bend Bulletin. “Since talking doesn’t pay, psychiatrist simply write prescriptions.” I’d like to mention another option to see for your mental health issues which seemed to be neglected in the article. I am a Psychiatric Mental Health Nurse Practitioner (PMHNP) in private practice in Bend. Http:// Advanced practice nurses, who have Masters or Doctoral degrees in their specialty, are independent providers in most states of the Union. In the specialty of psychiatry, we do psychiatric evaluations, order and interpret lab work, prescribe medications and do psychotherapy. Most of my patients I see for 45 minutes and many I see once or twice weekly. Most insurances will reimburse my fees. Many patients prefer us to psychiatrists as we spend more time with them listening to them. In fact, because I spend more time with my patients I feel I can be more effective in medication management and am more satisfying to the patient. I do not believe good medication management or any psychiatric care can be done in 15 minutes! For more information about PMHNP services in general please feel free to contact the American Psychiatric Nurses Association.

The stigma of mental illness continues in the year 2011

Recently, a friend and colleague of mine, Cara Hoepner, was interviewed on the radio as a representative for the National Association of the Mentally Ill (NAMI). She is a fellow Psychiatric Mental Health Nurse Practitioner in the state of California in private practice but also has “come out” as someone who struggles with Bipolar Disorder. I am very proud of her for talking about her disorder openly giving voice to the millions of people around the world who struggle with mental illness, as well as the stigma associated with it. Yes, stigma continues to be a huge problem in the year 2011!

Not long ago I was teaching a Sunday school lesson in my church. In the lesson, I spoke opening about some mental health issues in my family. I got permission from this family member to talk about it. I identified the illness by name and explained some of the problems related to that disorder. I was amazed to see a woman’s face with a horrified look on her face out in the audience shaking her head. She was clearly not pleased with what I was saying. As a mental health professional, I am keenly aware of HIPPA laws and the issue of privacy, but there needs to come a time when mental illness is not looked upon as something shameful that needs to be hidden! When I talk about heart disease or diabetes I have never got this type of reaction.

Another story…I used to belong to a book club. We read the book “The Glass Castle” which I highly recommend as a book that sheds light on the day to day living in a family with mental illness and addictions. Each of the members started talking about issues in their own family that have caused them pain. One particular woman started talking about her early childhood memories of an addicted mother with obvious mental health issues whose boyfriends abused her as a child. It was quite disturbing, but I was amazed that this woman, who has always avoided dealing with her issues in the past, had the courage to admit this in this group of women. Not everyone thought this was a good idea. One of the members quickly got up and left. I ached for the woman who shared the story that has had such impact on her life. Did she get the message that her life was too shameful to talk about? I wonder if she will ever share this with anyone again?

I would like to set the example at this time and admit that I have personally struggled with Depression and ADHD my whole life. I have also struggled with Diabetes in pregnancy and low iron levels. I am not ashamed of those conditions and I have obtained treatment for them.

In order to combat the huge problem of mental illness in this country, I challenge everyone to have the courage to admit mental health problems. It is not shameful! It is a chemical imbalance that is believed to be at least 50% related to genetics. I challenge businesses to decrease stigma and improve mental health parity by covering mental health illness treatment just like you would Diabetes or heart disease. We as a people all have a part in overcoming mental health stigma!

Stimulants not always the answer for Attentive Deficit Hyperactivity Disorder

In my practice, I’m amazed about how many people come to me and have taken some test online and have self-diagnosed themselves with ADHD or ADD and want me to give them stimulants. It happens every week. I also don’t know how many times I’ve had to tell these same people that stimulants may not be the answer to their problems and can even make their mental health symptoms worse! Let me give you a case in point of when stimulants may have done more harm than good.

Larry, (not his real name) is a 53 year old male who reports that he has taken Adderall or the equivalent for 30 years. He reports it makes him organized. It makes him be able to focus and concentrate and complete tasks. I take careful note but also observe that this same guy is very rigid, angry and irritable during our visit. He has a history of attempted suicide and has been hospitalized several times. He also tries to hide the fact that he lived in a reclusive situation away from civilization for years and has been unable to work for authority figures. He also reports he is estranged from friends and family.

Yes, it is true that stimulants help many people with focus and concentration. It is also the fact that ADHD is not the only condition that makes a person disorganized, unfocused and unable to complete tasks. For instance the guy above ended up being diagnosed with Schizophrenia. Other conditions like Bipolar Disorder, Depression, anxiety disorders and Thyroid Disorders can look like ADHD. Giving the above patient stimulants can bring out his rigidness, his anger and irritability and even psychotic symptoms. If one has tendencies toward obsessive compulsive disorder it would be especially important to avoid taking stimulants. Stimulants can make the OCD worse. A better way to go might be to effectively treat the OCD symptoms and the patient may find that their ADHD like symptoms greatly improve.

Sadly, years of stimulant misuse for the above patient made him so rigid in his expectations that he was psychologically unable to consider other possibilities for his problems. This is why it is so important that when suffering from ADHD like symptoms that a specialist who works regularly with the various mental illnesses be called upon to do the initial evaluation. It can potentially prevent years of problems and help a person become quickly more functional to reach his goals. I wish this guy could have been spared all the pain he went through! Can you imagine the implications for posterity and other family members?

Hoarding Disorder: A subtype of OCD or ADHD?

Most of us probably know someone who has issues with hoarding, whether it be our great aunt who saves newspapers and cannot throw any away because she plans on one day reading them all, or a neighbor who has 25 old cars on his property that haven’t been touched in years.   Hoarding can often be a debilitating condition that is hard to cure.  Hoarding is defined as the acquisition of and failure to discard large volumes of possessions, resulting in clutter that precludes normal use of living spaces.  Yes, you may  have seen television shows that devote their entire existence to our voyeuristic tendencies of peering into the households and lifestyles of mentally ill individuals with hoarding disorder.

Up until recent years, I have largely believed that hoarding is a subtype of obsessive compulsive disorder (or OCD).  That is what I was taught in graduate school, although I’ve noticed that over the years my patients haven’t necessarily met the criteria of someone who has OCD. Maybe sometimes, but not always. Alas, there is a recent study that casts further light on the difficulties of hoarding disorder.

In the December 2010 issue of the Behaviour Research and Therapy Journal appears a study that examines the core features of hoarding which include clutter, difficulty discarding and acquiring to decide whether hoarding is more like OCD or attention deficit hyperactivity disorder (ADHD).  Participants underwent careful diagnostic interviewing and completed questionnaires that measured features of hoarding, OCD symtoms, negative affect (or mood) and the inattentive and hyperactive/impulsive symptoms of ADHD.  What they found is that OCD symptoms did not significantly predict any of the core features of hoarding disorder. Instead what they found was the inattentive (but not hyperactive or impulsive) symptoms of ADHD significantly predicted the severity of clutter, difficulty discarding and acquiring.

I find this information very informative and is helping me reformulate my ideas and treatment plan for the problems related to hoarding disorder.

Is Cognitive Behavioral Therapy the best psychotherapy?

In my practice I usually focus on one of three types of therapies depending on the diagnosis and particular characteristics of the patient. For the most neurotic types of patients I find CBT to be the most effective. Neurotic types tend to take too much responsibility for the problems of the world. They tend to over think things. I find that CBT helps them be more realistic in their thinking process. These kinds of patients also often benefit from interpersonal therapy where we focus on relationships with people, communication skills and problem solving skills. For the more disorganized and psychotic patients I find that CBT is often too challenging for the patient. It is hard for them to organize themselves, do homework and challenge themselves without further disintegration of the ego. For these types of patients I tend to stick with interpersonal therapy, problem solving and supportive therapy.

There has been abundant research in recent years that demonstrate the effectiveness of Cognitive Behavioral Therapy (CBT) in the treatment of numerous mental health disorders. There was even one study that showed that it helped in reducing chronic pain syndromes. This begs the question whether or not CBT is the best psychotherapy out there for mental health disorders? Some believe that to be the case for some conditions.

In the August 2010 issue of the Clinical Psychology Review it reports an analytic meta-review of the subject. They compared CBT to psychodynamic therapy, interpersonal therapy and supportive therapy. Overall, what they found was that CBT was superior to psychodynamic therapy, although not interpersonal or supportive therapies, at post-treatment and at follow-up. Confirming my suspicions, they found CBT to be superior to the other therapies for 2 classes of conditions: anxiety and depressive disorders. For my practice, this is the most valuable therapy as I see more anxious and depressed types of patients than anything else. Probably makes up at least 90% of my patients.

Interestingly, my observation is that it helps almost everyone. I use it in marital therapy with good results! I even tend to use it on my own marriage–disguising it of course! I find that spouses don’t like to be what they call “psychoanalyzed.” So, I continue to do it but try to leave out all the lingo. Shhhh! Don’t tell my husband!

Mental disorders in unemployed young adults

Recently, I heard a statistic that really bothered me. It was that possibly as high as 40% of adults under the age of 25 in Europe were unemployed.
All over the United States as well as many other countries are showing increasing rates of mental health problems in youth. Simultaneously, we are seeing higher and higher rates of unemployment among this same age group. Are they related? It is highly likely.
One study from a Swedish University showing up in the European Journal of Public Health in December 2010 reports that being out of the workforce and not in education was associated with severe mental disorders. The risk of being hospitalized for depression was more than double and the risk of being hospitalized for self-harm and alcohol-related disorder was tripled among this population. Additionally, drug abuse was seven times more prevalent among economically inactive young adults.

From this study I believe it is urgent that our governmental leaders consider all angles of an issue when considering health care reform. Are we undertaking health care reform policies that as a result stifles the economy and puts more and more people out of work that as an end result excascerbates the original problem? I hope that we have leaders that are smarter than this!

Differentiating Bipolar Disorder from ADHD in children

There is a perception that ADHD is an over diagnosed condition in children. There have been studies over the years that have challenged that perception, even suggesting that ADHD is under diagnosed. At least one study that I know of reports that 75 % of the prison population meets criteria of ADHD. I would venture to believe that many in prison have never been properly identified or treated. I can’t help but wonder whether we could have changed the course of events for these prisoners had they been properly diagnosed and treated as children before they dropped out of school and turned to crime believing they were dumb and defective with few options.

One of the problems in diagnosing children is that sometimes ADHD is confused with bipolar disorder. There is a lot of overlap between these two brain diseases. There is an interesting study in the Journal of Affective Diseases this month that tries to determine the differences between these two diseases and the accuracy of The CBCL pediatric bipolar profile as a diagnostic measure. It found that children with bipolar disorder were verbally aggressive and argumentative, who respond with anger when frustrated. Children diagnosed with bipolar disorder and ADHD exhibited significant levels of impulsive behavior and attention problems, but youngsters with bipolar disorder also exhibited significant levels of aggressive behavior and dysphoric mood. Finally, the study found that the CBCL pediatric bipolar disorder profile did not accurately identify youngsters who were diagnosed with bipolar disorder.
So, although the news often reports that ADHD has sky rocketed in frequency in recent years, I suspect that some of those cases may very well be undiagnosed bipolar disorder. It is important to know the difference and to be aware that although certain symptoms of bipolar disorder may very well get better with some types of ADHD medications other symptoms can surely get worse. This is why it is so very important that a specialist in the field who daily works with these two types of conditions be the one to diagnose and treat your child. It can make all the difference in the world in the success of your child’s future.

Little known differences between bipolar depression and unipolar depression

In my practice I often see patients self referred or sent in by their general practitioner who tell me that he or she has Major Depressive Disorder. Problem is, medications and therapy have had little success so my expert advice is needed.

When evaluating a patient it is crucial not to miss the diagnosis of bipolar depression. A recent article in a Chilean medical journal (Rev Med Chili 2010 Jun) identifies suggestions of how a proper diagnosis can be achieved. This information resonates with my practical experience seeing patients through the years.

First it is important to use standardized diagnostic criteria such as the DSM-IV or ICD 10 manuals. Second it is important to check whether certain clinical features are present. These features tend to be less known to the general practitioner and population. These criteria include whether there are previous episodes of mood elevation. Mood elevation can include times when mood is either positively elevated as in euphoria or high energy that is distinct from other times, or it can be negatively elevated. An example of the latter would be “road rage”. One is driving and the person in front of him lingers a little too long at the stop sign and the drivers gets unusually angry and wants to punch the guy out. We all have heard of that happening.

Another lesser known criteria is current or past episodes of psychotic depression which are episodes of depression that are so severe and debilitating that a person has great difficulty getting out of bed in the morning and functioning.

Recurrent depressive disorder before the age of 25 and a strong family history of mood disorder and suicide are other red flags for Bipolar Disorder.

Finally there are the signs related to past antidepressant usage that can be valuable information in proper diagnosis. If a patient has had a lack of response or “wearing off” to well conducted antidepressant treatment, or an unusually fast response to antidepressants with features of elation these are all red flags of Bipolar Disorder.

Finally, it is important that the proper professionals are utilized in making the diagnosis. While it can be a starting place, it can not be adequately done by self-diagnoses through the internet!

Vitamin D links to mental illness

There is a growing body of evidence that many mental health conditions  are related to dietary deficiencies. A currently recognized deficiency these days is Vitamin D.

It is commonly reported these days that 75% of people have a deficiency of Vitamin D. This is all over the world. Interestingly, the country that is reported to have the highest Vitamin D levels isThailand.  I’m not sure it is known why that is. Vitamin D deficiency it turns out is related to many illnesses from Depression to Cancer. What is the recommended amount of Vitamin D these days?  In my practice I recommend a level no lower than 32 ng/ml. Although there is research that suggest levels of 50-70 are necessary to prevent Cancer.

People susceptible to Vitamin D deficiency are infants, pregnant and lactating women, the elderly, individuals living in Northern latitudes, those who avoid sun, and dark pigmented individuals.  There are also conditions that predispose a person to Vitamin D deficiency including people who have chronic renal failure, people with malabsorptions syndromes that come as a result of bariatric surgery, biliary tract disease, Cystic fibrosis, Celiac disease, inflammatory bowel diseases and certain medications.

If you are taking a Vitamin D supplement please be aware that it is recommended that you take Vitamin D3 as opposed to D2.  Most research uses Vit D3.  Also be aware that Vit A antagonizes the action of Vit D. (Attention Cod Liver Oil and Retinol users!)

Lastly, if you are being evaluated for Depression please have your medical practitioner check your Vit D levels before undergoing any other treatment. You may be able to save yourself a lot of time and money!