Brookhaven Hospital: Mental Health Treatment for Behavioral Health Problems, Chemical Dependency, Eating Disorders, Brain Injuries, and Renewal Christian Treatment and Recovery

Monday, December 31, 2007 5:11 PM
posted by Aric Thorpe, MHR

SAD: Season Affective Disorder

It's that time of the year again, a time when light is more scarce and darkness is abundant. Seasonal Affective Disorder, SAD for short, affects from 1.4 percent (in Florida) to 9.7 (in New Hampshire) this time of year, according to epidemiological studies. There are obvious similarities between the behavior seen in humans during the winter months and other mammals. In mammals during the dark months, burrowing, sluggishness, and excessive sleep is common. These traits contribute to the survival of mammals during the winter months. Many scientists theorize that SAD may be related to innate survival traits similarly found in humans. Exposure to industrial light may be a factor that reduces the prevalence of SAD. Additionally, artificial light in the morning may help to reduce nocturnal melatonin secretion, which contributes to SAD. The following is an excerpt of an article from the New York Times that discusses issues surrounding SAD:

In 2001, Dr. Thomas A. Wehr and Dr. Norman E. Rosenthal, psychiatrists at the National Institute of Mental Health, ran an intriguing experiment. They studied two patient groups for 24 hours in winter and summer, one group with seasonal depression and one without.

A major biological signal tracking seasonal sunlight changes is melatonin, a brain chemical turned on by darkness and off by light. Dr. Wehr and Dr. Rosenthal found that the patients with seasonal depression had a longer duration of nocturnal melatonin secretion in the winter than in the summer, just as with other mammals with seasonal behavior.

Why did the normal patients show no seasonal change in melatonin secretion? One possibility is exposure to industrial light, which can suppress melatonin. Perhaps by keeping artificial light constant during the year, we can suppress the “natural” variation in melatonin experienced by SAD patients.

There might have been a survival advantage, a few hundred thousand years back, to slowing down and conserving energy — sleeping and eating more — in winter. Could people with seasonal depression be the unlucky descendants of those well-adapted hominids?

Regardless, no one with SAD has to wait for spring and summer to feel better. “Bright light in the early morning is a powerful, fast and effective treatment for seasonal depression,” said Dr. Rosenthal, now a professor of clinical psychiatry at the Georgetown Medical School and author of “Winter Blues” (Guilford, 1998). “Light is a nutrient of sorts for these patients.

Click here to read the entire article from the New York Times

Click here for information on the treatment of depression

link to this post

Friday, December 21, 2007 12:24 PM
posted by Aric Thorpe, MHR

Crystal Meth fuels the fire of HIV/AIDS

A recent study published in the Dec 3, 2007 issue of AIDS Clinical Care reinforces preexistence evidence of the integral connection between HIV/AIDS and crystal meth. Crystal meth can cause its users to engage in risky sexual behavior, which is not unknown to its users. In fact, this is part of the sales point for the street drug. Meth increases sexual arousal and helps its users let go of their inhibitions, thus loosing their judgment in the process. Additionally, the drug is believed by its users to serve as an escape from depression, stress, and other emotional problems that might affect those with AIDS.

Unfortunately, there is a high prevalence of people with HIV/AIDS that use meth. In San Francisco, a study reported that 19-39% of those with HIV had used meth within the past year. Researchers believe that the risky behavior and loss of inhibition that meth causes is fueling the HIV/AIDS epidemic. Meth is not only helping to increase the spread of AIDS but is also worsening the health of those users that already have AIDS. The following is an excerpt of an article from Journal Watch that discusses the issue in-depth:

This high prevalence is alarming because CM use can increase the risk for HIV transmission and also contribute to poorer health outcomes in HIV-infected users.

CM use increases the risk for HIV transmission and acquisition in a number of ways. First, the drug lowers sexual inhibitions, impairs judgment, and provides the necessary energy and confidence to engage in sexual activity for long periods of time. As a result, methamphetamine users are more likely... to have sex with injection drug users, HIV-positive partners, and those of unknown HIV status; they also tend to report a greater number of sex partners and to have a history of other sexually transmitted diseases (STDs).

Click here to read the entire article from Journal Watch
link to this post

Wednesday, December 19, 2007 8:39 AM
posted by Aric Thorpe, MHR

Depression can lead to bone loss

A recent study revealed that depression can actually cause bone loss and osteoporosis. The study was conducted by scientists at Jerusalem's Hebrew University and used mice as test subjects. The mice were given drugs to create behavior similar to that of depression and, overtime, suffered bone loss, particularly in their vertebrae and hips. However, after the researchers gave the mice antidepressants the bone loss stopped and density actually increased. Depression creates a chemical called noradrenaline through activation of the sympathetic nervous system, which hurts bone building cells. Noradrenaline is blocked through the use of antidepressants reversing bone loss. According to Raz Yirmiya, a professor at Hebrew University, "These findings... for the first time point to depression as an important element in causing bone mass loss and osteoporosis.”

Click here to read an article from Reuters on the subject

Click here to learn about treatment options for depression

link to this post

Tuesday, December 18, 2007 7:52 AM
posted by Aric Thorpe, MHR

Campaign to raise awareness about childhood mental illness too successful?

New York University's Child Study Center recently commissioned a campaign to raise awareness about mental health issues among children that has sparked a public debate. The campaign, produced pro bono by BBDO, an Omnicom agency, features various ransom notes composed of newspaper clipping fonts, which have been displayed in Newsweek, New York Magazine and billboards around New York. Here's an example of one of the ransom notes:

"We have your son. We will make sure he will no longer be able to care for himself or interact socially as long as he lives." - Autism

Kristina Chew, founder of a blog called Autism Vox and mother of a ten year old son that has autism, was one of many extremely offended by the ads. Mrs. Chew said, "the reaction has been mostly outrage from parents of special-needs children, autistic adults, teachers, disability rights advocates and mental health professionals." Many feel that the ad is inappropriate because it features language that is so strong and projects these children as being criminalized. However, according to Dr. Harold S. Koplewicz, director of the New York University Child Study Center, "Children’s mental disorders are truly the last great public health problem that has been left unaddressed... It's like with AIDS. Everyone needs to be concerned and informed." Additionally John Osborn, CEO of BBDO, stated, "It's tricky because there are a lot of messages in the air particularly at holiday time. That makes it a challenge to cut through the clutter."

The campaign features several other notes written from the personalities of Asperger's, bulimia, depression, OCD, and ADHD.

The ad has certainly succeeded. It has sparked public debate and has made mental health issues among children more visible. I doubt, however, that Dr. Koplewicz, nor the folks over at BBDO, knew that the campaign would cause so much hullabaloo. The following is an excerpt of an article from the New York Times that discusses the issue:

Produced pro bono by BBDO, an Omnicom agency that worked on two previous campaigns for the Child Study Center, the campaign features scrawled and typed communiqués as well as simulations of classic ransom notes, composed of words clipped from a newspaper.

In addition to autism, there are ominous threats concerning depression, obsessive-compulsive disorder, attention-deficit hyperactivity disorder, Asperger’s syndrome and bulimia. The campaign’s overarching theme is that 12 million children “are held hostage by a psychiatric disorder.”

The public service announcements began running this week in New York magazine and Newsweek as well as on kiosks, billboards and construction sites around New York City.

“Children’s mental disorders are truly the last great public health problem that has been left unaddressed,” said Dr. Koplewicz, adding: “It’s like with AIDS. Everyone needs to be concerned and informed.”

In some quarters, however, the campaign has raised hackles as much as awareness. The Autistic Self Advocacy Network, a national grass-roots organization of children and adults, is circulating a petition asking the Child Study Center to end the campaign.

Click here to read the article from the New York Times

link to this post

Monday, December 17, 2007 7:31 PM
posted by Aric Thorpe, MHR

Child injury associated with depressed mothers

A recent study published in the Nov. 30th issue of Injury Prevention has found a clear connection between mothers with persistent elevated levels of depression and injuries among their children. According to Kieran Phelan, M.D. of Cincinnati Children's Hospital Medical Center, these injuries to children may be due to the tendency of mothers with depression to not provide adequate supervision for their children. For instance, mothers that are depressed may be more likely to leave electrical outlets uncovered, to not properly secure their children during commutes, or to not have batteries in their smoke detectors. The study found the highest rates of injury at home to be among children ages six and younger. The following is an excerpt of an article from Medpage Today that discusses the study's findings:

To examine that issue, they analyzed data on a subset of 1,106 mother-child pairs from the National Longitudinal Study of Youth, which has tracked a cohort of women and children from birth since 1986.

Maternal depressive symptoms were measured in 1992 by the Center for Epidemiologic Studies Depression Scale. Child behavior was assessed by the Behavior Problems Index externalizing subscale. The relationship between depressive symptoms, child behavior, and injury reported in the prior year in 1994 was studied by logistic regression analysis.

To reduce the likelihood that a child's injury may have contributed to the mother's depressive symptoms, the researchers excluded any child who had a medically attended injury in the year before 1992. Half of the children were boys, and almost 80% were from families with two or more children.

In total, 94 medically attended injuries were reported among 1,106 children (8.5%), of which two-thirds happened in the home environment.

Maternal depressive symptoms significantly increased the risk of child injury. Children of mothers with high and persistent depressive symptoms were more than twice as likely to be injured as children of mothers who did not have high depressive symptoms (adjusted OR: 2.10, 95% CI: 1.19 to 3.72).

Click here to read the entire article from Medpage Today

Click here to view treatment options for depression
link to this post

Thursday, December 13, 2007 8:50 AM
posted by Aric Thorpe, MHR

Potential dangers of bariatric surgery

Bariatric surgery, while providing hope for health among those that are obese, does have its potential dangers. According to a recent study published in the October edition of Archives of Surgery, approximately 1% of all bariatric surgery patients die within the first year of having the surgery and another 5% die within five years. When analyzing data surrounding patients receiving bariatric surgery in Pennsylvania from 1995 to 2004, researchers found that there were many deaths after the surgery that were not attributed to physical health but rather suicide.

The findings imply that more concentrated follow up could help reduce the death rate in bariatric patients in the long term after surgery. In particular, screening for depression would be key to such a follow up effort. However, clinicians would be well suited to watch for signs of diabetes and hypertension as well. It should be said after discussing the study's findings that the risk of not having the surgery often outweighs the risk involved in the surgery itself, especially in cases where candidates for the surgery are morbidly obese. The following is an excerpt of an article from Psychiatric Times that reviews the study's findings:

Starting with 32 procedures in 1995, 74 hospitals in the state performed steadily increasing numbers, peaking at 4,778 in 2003, before dropping back slightly to 3,818 in 2004.

All told, there have been 440 deaths recorded after 16,683 procedures, the researchers found.

The 30-day case fatality percentage was 0.9% overall. The rate increased with the age of the patient, reaching 3.1% for those 65 and older. There was no evidence that the 30-day fatality rate changed over time.

While 74 hospitals performed bariatric surgery, 90.3% of the procedures took place in just 32 hospitals and 48.2% in only eight, the researchers noted.

Of the 440 deaths, 82.7% took place among the patients of the 32 hospitals that contributed more than 90% of the procedures, Dr. Kuller and colleagues said.

Among the 440 deaths, there were 45 that the researchers defined as traumatic, including 16 due to suicide, 14 due to drug overdoses that were not classified as suicide, 10 due to motor vehicle crashes, three to homicide, and two to falls.

Based on U.S. vital statistics, the researchers estimated that three suicides should have occurred in this population, instead of the 16 that were seen. "There is a substantial excess of suicide deaths, even excluding those listed only as drug overdose," they said.

Among the remaining 395 deaths, the leading cause was coronary heart disease at 19.2%, followed by sepsis at 13.9%, pulmonary embolism at 11.9%, therapeutic complications at 11.4%, and cancer at 10.6%.

In his critique, Dr. Livingston pointed out that "lacking randomized trials, the effect of bariatric surgery on obesity-related mortality is inferential at best."

"What was unexpected," he said, "was the frequency of suicide and drug overdoses."

Click here to read the entire article from Psychiatric Times

Click here for information on treatment options for depression

link to this post

Wednesday, December 12, 2007 9:24 AM
posted by Rolf B. Gainer, Ph.D.

An Inherited Bias for PTSD

The adult children of individuals with PTSD show a reduction in cortisol production similar to that of their parents. It was also noted that many of the individuals in this group of adult children of PTSD parents also suffered from Mood Disorders. An article in the Archives of General Psychiatry, 2007, September, 64:1040 by R. Yehuda, M.D. described a study to assess low cortisol levels as a vulnerability factor in adult children of parents with PTSD. The study noted changes in the activity level of the hypothalamic-pituitary-adrenal (HPA) axis of the adult children cohort and further identified the possibility that these individuals are more likely to develop PTSD if exposed to a traumatic event.

Individuals with a low probability of developing PTSD have been studied by M. Friedman and reported in Neuropsychiatry Review, January 2006. Dr. Friedman noted that resilient individuals were capable of mobilizing a substance identified as "Neuropeptide Y". These individuals had a lower likelihood of developing PTSD even though they were exposed to the same wartime experiences as individuals who developed PTSD. Individuals without this mobilizing ability were seen as less resilient and more likely to develop long term effects of exposure to trauma. Dr. Friedman, like Dr. Yehuda observed changes within specific regions of the brain. The changes in both studies were lasting and, in the Yehuda study were found to effect the children of individuals with PTSD.

Clearly, the human brain reacts to long term stress exposure through establishing changes which will effect the individual and, as we now have learned, will create a bias for their children to be predisposed to certain psychological problems. Currently the Department of Defense is increasing their assessment of returning troops to determine if they have PTSD, Mild Brain Injury and other problems related to combat acquired physical and psychological injuries. We need to mindful that the effects of the injury may expand beyond the person. Charles Figley, Ph.D. refers to the process of contagion and secondary victimization in PTSD.

Mike Mason, a journalist who wrote "Dead Men Walking" in a recent issue of Discover magazine, interviewed military medical personnel as well as injured soldiers at Balad Hospital . He has presented their story at several brain injury conferences and recently at the Professional Seminar Series here at Brookhaven Hospital. The interviews conducted by Mr. Mason with the trauma physicians, nurses and the patients are remarkably similar in the context of being able to hear in the voices of these individuals the impact of their exposure to enormous trauma at primary and secondary levels. We will wait for the future to determine which of those people will develop PTSD or another disorder or which will escape the lasting psychological problems. I hope that we don't make these people or potentially, their children and family, wait to receive the help they may need.

link to this post

8:58 AM
posted by Aric Thorpe, MHR

Grieving Adults have higher instance of mortality and physical complaints

According to a recent synthesis of research published in the Dec 8 issue of The Lancet, grieving adults may have an increased risk for mortality as well as physical complaints. According to Margaret Stroebe, Ph.D., of Utrecht University, author of the study, men ages 55 and over have a 5% risk increase for mortality within six months of the death of their spouse. The increased rate of 5% is in comparison to a rate of 3% among men the same age whose wives were still alive. The research synthesized the findings of several studies surrounding the topic of bereavement after 1997. The findings from the sample studies varied. In fact, one study found a 66 fold increase in mortality risk for widowers. In addition to increased mortality, the study found that grieving people have an increased risk of physical complaints such as headaches, chest pain, dizziness, illness or disability, to name a few. The following is an excerpt of an article from Medpage Today that reviews the study:

Within the six months following the death of a wife, men 55 and older have a mortality rate of about 5% compared with a rate of 3% for same-age men whose wives are still living, wrote Margaret Stroebe, Ph.D., of Utrecht University, and colleagues, in the Dec. 8 issue of The Lancet.

The researchers searched the literature for studies of grief or bereavement published after 1997 and synthesized the results for a review article on the health outcomes of bereavement. They noted that most of the studies were from the U.S., Europe, and Australia.

A number of studies have focused on an excess risk of suicide while grieving for a loved one, the investigators noted, and those studies generally confirmed an increased risk for suicide, especially within the first week of bereavement -- one study reported a 66-fold increased risk for widowers and an 9.6-fold increased risk for widows. Moreover, the increased risk was often associated with alcohol consumption.

In addition to excess mortality, bereavement was associated with a greater occurrence of physical complaints "ranging from physical symptoms (e.g. headaches, dizziness, indigestion, and chest pain) to high rates of disability and illness," the authors wrote.

But while some studies found that these symptoms led to increased use of medical services, a number found no corollary with increased use of medical services, and, in one study of grieving women, doctors' visits actually decreased.

Click here to read the entire article from Medpage Today

Click here to read about treatment options for depression

link to this post

Friday, December 07, 2007 9:00 AM
posted by Aric Thorpe, MHR

Anxious people at risk for sleep disturbance after traumatic events

A recent study suggests that people with anxious personalities are more likely to develop sleep disturbance after traumatic events. According to a study published in the November 1st issue of the journal SLEEP, people with the highest levels of stress are 2.4 times more at risk of developing sleep disturbances after a traumatic event. However, the increased risk may dissipate after the first month following a traumatic event, according to Jussi Vahtera, M.D., and colleagues. Researches studied data from the longitudinal Health and Social Support study, whose sample was composed of Finnish inhabitants. The study analyzed responses from 19,199 individuals who took the survey in 1998 and then again five years later. The following is an excerpt of an article from Medpage Today that reviews the study's findings:

These findings from a large, population-based study provide prospective evidence that people who are anxious by nature are predisposed to sleep disturbances, the researchers said.

They analyzed data from the longitudinal Health and Social Support study with a representative sample of the Finnish population. The analysis included 19,199 respondents who completed a survey both at baseline in 1998 and five years later.

At baseline, participants fell into four age groups -- 20 to 24, 30 to 34, 40 to 44, or 50 to 54 -- and 13% reported sleep disturbances. At follow-up, 11% reported new-onset sleep disturbances.

Liability to anxiety, indicated by a general feeling of stressfulness (as measured by the Reeder stress inventory) and symptoms of sympathetic nervous system hyperactivity, was strongly linked to disturbed sleep, the researchers said.

Men and women with the highest levels of general stress on a day-to-day basis were 2.4 times more likely to develop new-onset sleep disturbances compared with those in the lowest quartile (95% confidence interval 2.0 to 2.7). For symptoms of sympathetic nervous system hyperactivity, the odds of developing sleep disturbances were 2.2 times higher for those in the highest quartile than for those in the lowest quartile (95% CI 1.9 to 2.5).

Click here to read the entire article

Click here for information on the treatment of anxiety disorders

link to this post

Thursday, December 06, 2007 5:18 PM
posted by Aric Thorpe, MHR

Ten tips for holiday sobriety

The Holidays are filled with temptations for the person struggling with an addictive disorder. There are work and social events, "get together’s" with family and friends, and celebrations of all kinds. For the person who is in recovery, the holiday period can provide additional stress and triggers which can cause relapse. Here are a few helpful ideas to assist you in enjoying the many positive aspects of the season as well as your sobriety.

Know what "triggers" your substance use. Avoid situations in which your triggers will be present. That may mean staying away from people, places and activities that are associated with your past substance use.

Take a buddy with you. Is there a situation where temptation resides that you simply cannot avoid? Perhaps there is that annual employee Christmas party that you are required to attend. Maybe Christmas Eve, or even Christmas morning, are drenched with uncle Jack’s “special” eggnog. Taking an accountability partner with you could be the difference between success and failure in those unavoidable situations.

Make an itinerary for the holidays. Yes, it may seem foolish, but having a daily game plan during the holidays will prevent others from making one for you. Be purposeful and exact, paying particular attention to plan events during times that you know temptation will be present. Don’t be driven with the winds of spontaneity but hoist your sail, set your rudder and determine your own course during the holidays.

Attend meetings and social events which you know will support your sobriety. Take in a few extra meetings to enjoy the support and camaraderie of your sober friends. Stay closely connected to your recovery group during the season.

If you are attending a social event which may provide triggers, such as a work or social party, consider strategies such as:

Staying away from the bar area, making sure that you have a non-alcoholic beverage in your hand at all times
Avoid those people who say "come on, just one for the season”
Leaving early and avoiding the extended after-party activities can get you away from situations leading to substance use.
-Or - consider not going at all if you think the party will lead to substance use.

In the midst of preventative planning, have fun! Jubilation, thanksgiving, and family are at the heart of the season. Occupation through entertainment can help immensely. Don’t be tricked into thinking that you can’t have any fun during the holidays without alcohol. Get into the spirit of the holidays; merry making is in the air!
Slow down the social scene. Often the urge to drink comes in the form of peer pressure. Who says that you must go out every night? Why not stay at home with the family? Enjoy the old Christmas time movies on TV or as DVD's. Build a fire in your fireplace and make popcorn. Bake cookies. Take a brisk winter walk to look at the neighborhood lights!

Stay clear of HALT: Hunger, anger, loneliness, tiredness. Adding to the complexity of the equation to stay sober during the holidays is seasonal depression. People are particularly susceptible to feeling alone during the holidays, due to isolation from family or involvement with work, which can led to drinking. Additionally, carrying some candy with you may help to both occupy your mouth and replace the sugary aftertaste that some feel alcohol affords them.

Avoid "down time.” If you run out of ideas for activities while planning your holiday itinerary there are many non-profits which would love to help you conjure some up. Look into volunteering and opportunities to help other people. After all, giving is what the season is all about.

Lastly, carry your cell phone with you. If you are not at a AA meeting or with an encouraging someone during a moment of temptation, it is nice to have an accountability partner on speed dial. Talking to an encouraging friend is almost always more effective than arguing with your temptation. Making that call when temptation presents itself will help you get alcohol off of your mind.

Holiday times are stressful for everyone. Take the opportunity to plan ahead and avoid the temptations that could cause your relapse. You can have a great time over the Holiday Season remaining sober. Be responsible for yourself!

link to this post

8:57 AM
posted by Aric Thorpe, MHR

Is body dysmorphic disorder biological?

People with body dysmorphic disorder (BDD) see themselves as being unattractive, ugly, or disfigured. Often people suffering from BDD will opt to have plastic surgery or facial reconstruction to deal with the way they perceive themselves to appear. Additionally, people with BDD often are diagnosed with OCD (obsessive compulsive disorder) and / or develop eating disorders in order to deal with their negative self-image. BDD tends to run in families, which would suggest that the disorder is genetic rather than being caused by media imposed images of perfection alone; while family history suggests that there are biological origins for the disorder a recent study from UCLA confirms that idea.

According to the study, people with BDD don't seem to have any physical brain abnormalities but do appear to have a visual processing malfunction that accounts for the disease. According to Dr. Jamie Feusner, professor of psychiatry at UCLA Semel Institute, ""Our discovery suggests that the BDD brain's hardware is fine, but there's a glitch in the operating software that prevents patients from seeing themselves as others do." The study, which focused on 12 participants with BDD and 12 controls, found that patients with BDD tend to analyze images more with their left brains, the analytically orientated side of the brain, than controls. Here is an excerpt of an article from News-Medical.net that discusses the details of the study:

For the first time, functional magnetic resonance imaging (fMRI) was used to reveal how the patients' brains processed visual input. The UCLA team outfitted 12 BDD patients with special goggles that enabled them to view digital photos of various faces as they underwent a brain scan.

Each volunteer viewed three types of images. The first type was an untouched photo. The second type was a photo altered to eliminate facial details that appear frequently, such as freckles, wrinkles and scars. This "low frequency" technique blurred the final image.

The third type of image essentially subtracted the blurred second image from the untouched photo. This "high frequency" technique resulted in a finely detailed line drawing.

Feusner's team compared the BDD patients' responses to 12 control subjects matched by age, gender, education and handedness. What the scientists observed surprised them.

"We saw a clear difference in how the right and left sides of the brain worked in people with BDD versus those without the disorder," noted Feusner.

BDD patients more often used their brain's left side -- the analytic side attuned to complex detail -- even when processing the less intricate, low-frequency images. In contrast, the left sides of the control subjects' brains activated only to interpret the more detailed high-frequency information. Their brains processed the untouched and low-frequency images on the right side, which is geared toward seeing things in their entirety.
"We don't know why BDD patients analyze all faces as if they are high frequency," said Feusner. "The findings suggest that BDD brains are programmed to extract details -- or fill them in where they don't exist. It's possible they are thinking of their own face even when they are looking at others."

Click here to read the entire article from News-Medical.net

Click here for information on the treatment of eating disorders

link to this post

Rolf B. Gainer, Ph.D., Diplomate ABDA, is the Chief Executive Office at Brookhaven Hospital and the Vice President of Rehabilitation Institutes of America. Dr. Gainer has been involved in the design and operation of treatment programs since 1977.

Stephen Harnish, MD is the Medical Director of Brookhaven Hospital. Dr. Harnish is a member of the American Psychiatric Association and is well known in Oklahoma for his informative radio and television appearances.

Aric Thorpe, MHR, is Brookhaven Hospital's Pastoral Liaison Representative. He conducts the quarterly Minister's Lifeline series and provides mental health information to pastors and clergy.

Sarah McGee serves as the Community Education Provider for Brookhaven Hospital. She provides information on mental health and drug and alcohol treatment to healthcare professionals in Oklahoma and surrounding states.

| Outpatient Services |