Tag Archives: psychiatry

Suicide: Faces We See, Hearts We Cannot Know…¹

The recent suicide of actor Robin Williams is a tragic reminder of one of our society’s epidemics. Many have been left wondering, “How can such a talented and funny man end his life?” Robin Williams’ struggles with substance use and mental illness may have been public but, like many people around the world, his private turmoil and demons won the battle.

According to the latest data provided by the Centers for Disease Control and Prevention (CDC), suicide represented the tenth leading cause of death in the United States in 2011. If this were not alarming enough, suicide was the second leading cause of death among our teenagers and young adults (ages 15 to 34).

Recognition of warning signs, early prevention, and immediate assistance for anyone who expresses thoughts of suicide or attempts suicide are of great importance.

WHAT ARE SOME OF THE WARNING SIGNS?

Many warning signs for suicidal behavior are similar to symptoms of depression:

Feelings of sadness or hopelessness
Behavioral changes
Irritability
Anxiety
Trouble sleeping
Changes in appetite
Loss of interest in pleasurable or enjoyable activities
Poor hygiene
Feelings of guilt
Isolation from friends and family
Giving away or throwing out objects of personal value
Drug or alcohol abuse
Talk/verbal threats of suicide
Suddenly recovering from a period of depression (maybe after having decided to put an end to their suffering by ending their life)

Even in the presence of all these warning signs, it is extremely difficult to predict with certainty who will attempt suicide. We do know that the most important risk factor for the prediction of suicide is past suicidal behavior. In other words, a past suicide attempt is the best predictor of a future suicidal act.

RISK FACTORS FOR SUICIDAL BEHAVIOR:

Risk factors for suicide vary greatly from person to person depending on the severity of mental illness, personality strengths and vulnerabilities, and support system. The following list is not meant to be all-inclusive.

Sudden stressful life events (i.e. humiliating events, financial ruin, job loss, death of a loved one)
Interpersonal conflict
Economic problems
Legal problems
Mental illness
Medical problems (acute and chronic)
Intractable physical pain
Poor support system

WHAT CAN WE DO TO PREVENT SUICIDE?

It is important to recognize the above warning signs and risk factors as well as the symptoms of mental illness and alcohol/drug abuse. Early intervention is the most effective way to prevent suicide. Any statement of suicidal thoughts or suicidal behavior must be taken seriously. Anyone who expresses thoughts of suicide requires immediate medical evaluation.

WHAT ARE THE EFFECTS OF SUICIDE ON THE SURVIVORS?

The effects of suicide on friends and family can be devastating. People who lose a loved one to suicide tend to feel guilty for the death of their family member or friend, wonder what they could have done to prevent it, and may even feel rejected by others.

Suicide survivors may experience:

Sadness for their loss
Anger towards the deceased family member
Feelings of guilt
Depression
Anxiety
Posttraumatic stress disorder, especially when a witness to the suicide or finding the family member after a completed suicide
Suicide attempts to reconnect with their lost loved one

As the aftermath of family suicide may have long lasting effects, it is important for survivors of suicide to seek help in dealing with their loss.

HOW TO HELP?

Anyone who expresses thoughts of suicide or attempts suicide should be evaluated immediately:

Calling 911,
Taking the person (yourself) to the nearest emergency room, or
Looking for help from a mental health professional

Psychotherapy and counseling can help the suicidal person deal with his/her feelings or negative thoughts, identify stressors, and strengthen coping skills. Psychiatric medications may also control symptoms of depression, anxiety or any other mental health condition.

Help is also available through telephone hotlines. In the United States, the National Suicide Prevention Lifeline (1-800-273-TALK or 1-800-273-8255) is an excellent source of support. It is for people in crisis, not just when thinking about suicide. The call is free and confidential and a mental health professional will be available to listen to you and provide information about mental health services in your community.

There is no shame in seeking help and it can save your life!

Remember…

Be Smart. Be Safe. Be Healthy. Be Strong.

Until next time!

Dr. Felix

El Suicidio: Caras Vemos, Corazones No Sabemos…

¿Simplemente Irresistible? – Trastornos del Control de Impulsos

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Luis Suárez, jugador de fútbol con la Selección Nacional de Uruguay representando a su país en la Copa Mundial de la FIFA 2014 en Brasil, ha ganado fama en la última semana. No tan solo por sus habilidades en la cancha pero por la mordida vista alrededor del mundo. Según reportado, ésta es la tercera vez en su carrera que Suárez ha mordido a un oponente en el campo. Dicho comportamiento antideportivo ha dejado a muchos amantes del fútbol preguntándose, ¿qué le pasa a Suárez?

Uno de los diagnósticos de salud mental especulados por comentaristas deportivos, e incluso por expertos en salud mental, ha sido el trastorno del control de impulsos. Mientras que mostrar agresión en momentos de alto estrés, como el morder a otro ser humano, puede ser característico de una falta de control de impulsos, diagnosticar a una persona sin haberla evaluado, ya sea una figura pública o no, no es ni responsable ni ético. Pero aprovechando que el tema ha dado mucho de qué hablar en los medios noticiosos, creo que es importante tomar esta oportunidad para dialogar acerca de los trastornos del control de impulsos, cómo se manifiestan, y cómo tratarlos.

En primer lugar, el trastorno del control de impulsos no es un diagnóstico formalmente reconocido por el Manual Diagnóstico y Estadístico de los Trastornos Mentales, Quinta Edición (DSM-5, por sus siglas en inglés). Junto con los trastornos disruptivos y de conducta, describen un conjunto de diferentes diagnósticos que se caracteriza por “problemas en el auto-control de las emociones y los comportamientos,”¹ y que incluyen el trastorno negativista (oposicional) desafiante, trastorno explosivo intermitente, trastorno de conducta, trastorno de la personalidad antisocial, la piromanía, y la cleptomanía. Estos trastornos implican la violación de los derechos de terceros y/o “llevan al individuo a un significante conflicto con las normas sociales o figuras de autoridad.”² Estos trastornos tienden a ser más comunes en hombres que en mujeres, se manifiestan inicialmente en la infancia o en la adolescencia temprana, y no ocurren con gran frecuencia.

Aquí un breve resumen de estos trastornos, los cuales deben causar gran molestia en el individuo o afectar su nivel de funcionamiento:

Trastorno Negativista (Oposicional) Desafiante

Por lo general, comienza en los años preescolares.

¿Qué tan común? Cerca de 3.3%.³

Signos/Síntomas: frecuente mal genio, enojo/resentimiento, discusiones/peleas con figuras de autoridad, desafío de las reglas, culpar a otros por sus errores/mal comportamiento, conducta vengativa.

Trastorno Explosivo Intermitente

Por lo general, comienza tarde en la infancia o en la adolescencia.

¿Qué tan común?: Cerca de 2.7%.⁴

Signos/Síntomas: Arrebatos del comportamiento caracterizados por una falta de control sobre impulsos agresivos y que se manifiestan a través de la agresión verbal, daño/destrucción de la propiedad, o agresión física contra otras personas o animales. El arrebato no puede ser premeditado y su magnitud es grandemente exagerada comparada a cualquier posible provocación o factor estresante.

Trastorno de Conducta

Por lo general, comienza entre mediados de la niñez a mediados de la adolescencia.

¿Qué tan común?: Cerca del 4%.⁵

Signos/Síntomas: Violación de los derechos humanos o de las normas/reglas de la sociedad manifestada por el acoso/intimidación de otros, uso de un arma que puede causar daños graves, crueldad física hacia personas o animales, destrucción de propiedad, robo, y serias violaciones de las reglas.

Trastorno de Personalidad Antisocial

Nunca es diagnosticado antes de los 18 años, pero síntomas de trastorno de conducta deben estar presentes antes de los 15 años de edad.

¿Qué tan común?: De 0.2 a 3.3%.⁶

Signos/Síntomas: “Patrón general de desprecio y violación de los derechos de los demás”⁷ que se manifiesta por una conducta ilícita, falsedad, impulsividad, irritabilidad/agresividad, temerario desprecio por la seguridad, irresponsabilidad consistente, y falta de remordimiento.

Piromanía

No hay datos suficientes para determinar una edad general para el comienzo de este trastorno.

¿Qué tan común?: Desconocido.

Signos/Síntomas: Prender fuegos de manera deliberada; la persona siente tensión antes del acto seguido por placer, gratificación o alivio una vez que se prende el fuego; fascinación/atracción por el fuego.

Cleptomanía

El comienzo de este trastorno tiene edad variable.

¿Qué tan común?: De 0.3 a 0.6%⁸; las mujeres superan en número a los hombres de 3 a 1.

Signos/Síntomas: Inhabilidad para resistir el impulso de robar cosas que no son necesarias para el uso personal o por su valor; la persona siente tensión antes del acto seguido por placer, gratificación o alivio una vez que el robo es cometido.

Otros Trastornos Disruptivos, de Control de Impulsos, y de Conducta

Presentaciones clínicas en que los síntomas de la desregulación emocional o del comportamiento provocan significante molestia o deterioro para el individuo, pero que no cumplen con los criterios para uno de los trastornos arriba mencionados.

¿Cómo se tratan estos trastornos?

Los trastornos del control de impulsos se pueden tratar con la terapia y/o medicamentos. Detección e intervención temprana son sumamente importantes, sobre todo cuando algunos de estos trastornos pueden resultar en problemas con el sistema legal. Un experto en salud mental puede evaluar el historial del individuo y su presentación actual para determinar la presencia de algún trastorno psiquiátrico y establecer el mejor plan de tratamiento. Existen diferentes terapias del comportamiento que han demostrado ser eficaces para el tratamiento de estos trastornos y que sólo debe ser realizadas por un experto en salud mental.

Puede que nunca sepamos qué, si algo, está mal con Suárez. Pero al menos su conducta nos ha dado la oportunidad de hablar de estos temas importantes mientras que el mundo está observando.

Recuerda…

Sé Inteligente. Sé Precavido. Sé Saludable. Sé Fuerte.

¡Hasta la próxima!

Dr. Félix

Simply Irresistible? – Impulse Control Disorders

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Luis Suárez, soccer player with the Uruguay National Team representing his country at the 2014 FIFA World Cup in Brazil, has recently gained some notoriety. Not so much for his abilities as a soccer player but for the bite seen around the world. And this is reportedly the third time in his career when he has bitten an opponent on the field. The unsportsmanlike behavior has left many soccer enthusiasts wondering, what is wrong with Suárez?

One of the mental health diagnoses being thrown around by sports commentators, and even mental health experts, has been that of impulse control disorder. While displaying aggression at the height of a stressful event, like biting another human being, may be characteristic of a lack of impulse control, making a diagnosis without evaluating a person, whether a public figure or not, is neither responsible nor ethical. But since the topic has been on the news, I think it is important to have a discussion about impulse control disorders, how they manifest, and how to treat them.

First of all, impulse control disorder is not an actual diagnosis recognized by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Together with disruptive and conduct disorders, they describe a set of different diagnoses characterized by “problems in the self-control of emotions and behaviors,”¹ which include oppositional defiant disorder, intermittent explosive disorder, conduct disorder, antisocial personality disorder, pyromania, and kleptomania. These disorders involve the violation of the rights of others and/or “bring the individual into significant conflict with societal norms or authority figures.”² They tend to be more common in males than females, initially manifest in childhood or early teenage years, and are generally rare.

Here is a brief overview of these disorders, all of which must cause distress in the individual or impairment in his/her level of functioning:

Oppositional Defiant Disorder

Usually begins in preschool years.

How common: About 3.3%.³

Signs/Symptoms: Frequent loss of temper, anger/resentfulness, arguments with authority figures, defiance of rules, blaming others for mistakes/misbehavior, vindictiveness.

Intermittent Explosive Disorder

Usually begins in late childhood or adolescence.

How common: About 2.7%.⁴

Signs/Symptoms: Behavioral outbursts characterized by a failure to control aggressive impulses and manifested through verbal aggression, damage/destruction of property, or physical injury against others/animals. The outbursts cannot be premeditated and are grossly out of proportion to any provocation or stressor.

Conduct Disorder

Usually begins in mid-childhood to mid-adolescence.

How common: About 4%.⁵

Signs/Symptoms: Violation of the rights of others or society norms/rules manifested by bullying/intimidation of others, use of a weapon that can cause serious harm, physical cruelty towards people or animals, destruction of property, deceitfulness, theft, and serious violations of rules.

Antisocial Personality Disorder

Never diagnosed before age 18 but symptoms of conduct disorder must be present before age 15.

How common: 0.2 to 3.3%.⁶

Signs/Symptoms: “Pervasive pattern of disregard for and violation of the rights of others”⁷ manifested by unlawful behavior, deceitfulness, impulsivity, irritability/aggressiveness, reckless disregard for safety, consistent irresponsibility, and lack of remorse.

Pyromania

Insufficient data to determine when it usually begins.

How common: Not known.

Signs/Symptoms: Deliberate fire-setting; tension before the act followed by pleasure, gratification or relief once a fire is set; and fascination/attraction to fire.

Kleptomania

Variable age of onset.

How common: 0.3 to 0.6%⁸; females outnumber males 3 to 1.

Signs/Symptoms: Failure to resist impulses to steal things that are not needed for personal use or for their value; tension before the act followed by pleasure, gratification or relief once the theft is committed.

Other Disruptive, Impulse-Control and Conduct Disorders

Presentations in which symptoms of emotional or behavioral dysregulation cause clinically significant distress or impairment to the individual but that do not meet full criteria for any of the disorders above.

How are these disorders treated?

Impulse control disorders may be treated with therapy and/or medications. Early detection and intervention are important, especially when some of these disorders may bring the person in contact with the legal system. A mental health expert may evaluate the individual’s history and current presentation to determine the presence of a disorder and to establish the best treatment plan. There are different behavioral therapies that have proven effective for the management of these disorders and which should only be performed by a licensed provider.

We may not know what, if anything, is wrong with Suárez, but at least his behavior has given us the opportunity to talk about these important topics while the world is watching.

Remember…

Be Smart. Be Safe. Be Healthy. Be Strong.

Until next time!

Dr. Felix

The Dangers of Molly

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“Molly” has been recently popularized in songs by Miley Cyrus and Kanye West. With lyrics like, “We like to party / Dancing with Molly / Doing whatever we want” [We Can’t Stop] and “Let’s take it back to the first party / When you tried your first molly / And came out of your body” [Blood on the Leaves], the use of the drug “Molly” has been praised and glamorized.

But, what is Molly?

Molly is a pure form of MDMA, or 3,4-methylenedioxy-methamphetamine by its chemical name. MDMA is one of the ingredients of another popular drug, Ecstasy (which may be mixed with caffeine, LSD, speed, ketamine, talcum powder, and aspirin). Regardless of its composition, ingestion of MDMA can be dangerous and even fatal.

MDMA was first synthesized by the German pharmaceutical company Merck in 1912. It was used in the late 1970s, without the approval of the Food and Drug Administration (FDA), as an aid in psychotherapy and marital counseling. As of 1985, the Drug Enforcement Administration (DEA) has categorized MDMA as a Schedule I controlled substance due to its high potential for abuse and no accepted medical use in treatment.

MDMA is similar to the stimulant amphetamine and the hallucinogen mescaline. Taken orally in tablet or capsule form or snorted as a powder, MDMA produces an energy rush, elevated mood or euphoria, distorted perceptions, and heightened feelings of empathy. These “desired” effects are what drive people, mainly teenagers and young adults in the club and rave scene, to try and even abuse the drug, at times not fully aware of the dangers, both short- and long-term.

The number of emergency room visits related to MDMA use has more than doubled in the last 7 years. According to the Substance Abuse and Mental Health Services Administration’s Drug Abuse Warning Network report of 2011¹, there were an estimated 22,498 emergency room visits (compared to 10,227 in 2004). And the numbers keep rising…

MDMA causes a release of brain chemicals (neurotransmitters), including dopamine, serotonin and norepinephrine. The massive release of serotonin as well as its eventual depletion lead to the negative effects of the substance, as detailed below:

Central Nervous System Effects:

Altered mental status (confusion)
Hyperactivity, restlessness
Seizures
Anxiety
Paranoia
Depression
Blurred vision
Hallucinations
Intracranial hemorrhage
Stroke

Cardiovascular Effects:

Tachycardia (increased heart rate)
High or low blood pressure
Chest pain
Fatal arrhythmia
Heart failure (risk increased in individuals with pre-existing cardiac disease)

Gastrointestinal Effects:

Dry mouth
Nausea
Vomiting
Abdominal cramping
Loss of appetite

Respiratory Effects:

Breathing difficulty
Respiratory failure
Aspiration (inhaling vomit)

Other Signs and Symptoms:

Dehydration
Excessive thirst
Profuse sweating
Teeth grinding
Jaw clenching
Muscle spasm

MDMA toxicity may also lead to the potentially fatal Serotonin Syndrome, causing:

Hyperthermia (dangerously high fever)
Altered mental status (confusion)
Heart rate and blood pressure abnormalities
Muscle rigidity (tightness)
Death

Increased water intake (from heat and thirst) as well as the excessive sweating from physical exertion (dancing often in crowded and hot conditions) may lead to hyponatremia (low sodium levels). Severe hyponatremia may result in brain swelling, seizures, and death.

Most MDMA-related fatalities are attributed to symptoms of heat stroke and hyperthermia. Other causes include: dehydration, rhabdomyolysis (excessive muscle breakdown), acute kidney failure, electrolyte imbalance, cardiac arrhythmias, and stroke.

It is important to be aware of the effects of this potentially fatal drug. As if these effects were not of enough concern, MDMA may be used in the club/rave scene together with other drugs and/or alcohol, leading to a possibly fatal combination.

Beware of the several names used for MDMA, including: Molly, Mandy, Ecstasy, E, XTC, X, Adam, Clarity, Lover’s Speed, Roll, MD, Mad Dog, among others.

Remember…

Be Smart. Be Safe. Be Healthy. Be Strong.

Until next time!

Dr. Felix

Teen Suicide

To Take, or Not To Take: That is the Question… Medications for Psychiatric Illness

PTSD and Response to Traumatic Events in the Aftermath of the Boston Marathon Bombings, Sandy Hook and Other Recent Tragedies

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Following recent traumatic events, such as the Boston Marathon bombings, the Sandy Hook massacre in Newtown, Connecticut, and other tragedies in the United States and around the world, it is imperative to address the importance of early recognition and treatment of acute and posttraumatic stress disorders.

Acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) may arise after direct exposure to a traumatic event, actual or threatened death of a family member or close friend, or repeated exposure to details about a traumatic event (1). Symptoms of ASD and PTSD are fairly similar and the distinction is largely based on the time frame to the beginning and duration of symptoms. Symptoms related to ASD last up to four weeks and must arise within one month of exposure to the traumatic event. In PTSD, the duration of symptoms is beyond 30 days. While your repeated exposure to details of a traumatic event from media coverage is not considered a cause of ASD and PTSD, the impact of graphic and violent images may affect people in different ways and may lead to temporary mood changes or worsen any pre-existing depressive or anxiety disorders.

The lifetime prevalence of PTSD in the United States adult population is estimated to be 6.8% (2). Women may be up to three times more likely to develop PTSD than men. Risk factors to develop PTSD, in addition to exposure to a traumatic event, include: being a female, having other mental illnesses (like depression and anxiety), having a family history of psychiatric illness, being a victim of abuse, or having a poor support system.

The following are key symptoms of PTSD but this condition may affect you in many different ways. Symptoms may also become severe enough to the point that they affect your day-to-day life and functioning.

Flashbacks or intrusive thoughts about the trauma

Nightmares or recurring dreams (about the trauma or with related themes)

Avoidance of memories or outside cues that remind you of the trauma (for example: blocking memories, avoiding conversations about the trauma, or driving the long way home to avoid the intersection where your car accident occurred)

Anxiety

Being easily frightened or startled

Sleep problems

Difficulty concentrating

Irritability or anger

Survivor’s guilt

Social isolation

Depression

Loss of interest in pleasurable activities

Feelings of detachment or numbness

Inability to fully express your emotions

Mistrust of others

Thoughts of suicide or suicide attempts

Early intervention following a traumatic event is important. For some people, talking about it with a family member or friend (“getting it off your chest”) may be enough. Others may need longer treatment with therapy and even medication.

Talk about your feelings: How safe do I feel? How has the trauma affected me? Am I afraid to leave the house? Am I self-medicating with drugs or alcohol? Why is my family so worried? What can I do?

The National Suicide Prevention Lifeline (1-800-273-TALK or 1-800-273-8255) is an excellent source of support. It is for people in crisis, not just if you are thinking of ending your life. When you dial Lifeline, your call is routed to the crisis center closest to your location. The call is free and confidential. Someone will be there to listen to you and to provide you with information on mental health services in your community.

Remember, there is no shame in seeking help. We all need a little push every now and then.

Be Smart. Be Safe. Be Healthy. Be Strong.

Until next time!

Dr. Felix

Trastorno de Estrés Postraumático a Consecuencia del Atentado del Maratón de Boston, Sandy Hook y Otras Tragedias Recientes

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Después de acontecimientos recientes, como el atentado del Maratón de Boston, la masacre de Sandy Hook en Newtown, Connecticut, y otras tragedias en los Estados Unidos y alrededor del mundo, es imprescindible abordar la importancia de la detección temprana y el tratamiento de los trastornos de estrés agudo y postraumático.

El trastorno de estrés agudo y el trastorno de estrés postraumático pueden surgir después de la exposición directa a un acontecimiento traumático, muerte o amenaza de muerte de un familiar o amigo cercano, o la exposición repetida a los detalles de un evento traumático (1). Los síntomas del trastorno de estrés agudo y el trastorno de estrés postraumático son bastante similares y la distinción se basa en el tiempo transcurrido al inicio de los síntomas y a su duración. Los síntomas del trastorno de estrés agudo duran hasta cuatro semanas y deben surgir dentro de un mes después de la exposición al evento traumático. En el trastorno de estrés postraumático, la duración de los síntomas continúa más allá de 30 días. Mientras que tu exposición repetida a los detalles de un evento traumático difundidos en los medios de comunicación no se considera una de las causas de estos desordenes de estrés, el impacto de las imágenes gráficas y violentas puede afectar a personas de diferentes maneras y puede conducir a cambios temporeros de humor o empeorar algún trastorno depresivo o de ansiedad anteriormente diagnosticado.

La prevalencia del trastorno de estrés postraumático en la población adulta de los Estados Unidos se estima en 6.8% (2). Las mujeres pueden estar hasta tres veces más propensas a desarrollar este trastorno en comparación a los hombres. Los factores de riesgo para desarrollar el trastorno de estrés postraumático, además de la exposición a un evento traumático, son: ser mujer, tener otras enfermedades mentales (como la depresión y la ansiedad), tener un historial familiar de enfermedad psiquiátrica, haber sido víctima de abuso, o tener un pobre sistema de apoyo.

Los siguientes son los síntomas principales del trastorno de estrés postraumático, pero esta condición te puede afectar de muchas diferentes maneras. Los síntomas también pueden ser lo suficientemente graves como para afectar tu vida y funcionamiento diario.

Imágenes impactantes (“flashbacks”) o pensamientos intrusivos sobre el trauma

Pesadillas o sueños recurrentes sobre el trauma o temas relacionados

Evitar recuerdos o señales externas que te recuerden el trauma (por ejemplo, la represión de memorias, el evitar conversaciones sobre el trauma, o conducir el camino mas largo de regreso a casa para evitar la intersección donde se produjo tu accidente de automóvil)

Ansiedad

Asustarte fácilmente

Problemas del sueño

Dificultar a concentrarte

Irritabilidad o enojo

Sentimientos de culpabilidad como sobreviviente del trauma

Aislamiento social

Depresión

Pérdida de interés en actividades placenteras

Sentimientos de desapego o entumecimiento emocional

Incapacidad para expresar plenamente tus emociones

Desconfianza de los demás

Pensamientos de suicidio o intentos de suicidio

La intervención temprana después de un evento traumático es importante. Para algunas personas, hablar del trauma con un familiar o amigo (“sacárselo del pecho”) puede ser suficiente. Otras personas pueden necesitar tratamiento más prolongado con terapia e incluso medicamentos.

Habla de tus sentimientos: ¿Qué tan seguro me siento? ¿Cómo me ha afectado el trauma? ¿Tengo miedo de salir de casa? ¿Me estoy automedicando con drogas o alcohol? ¿Por qué mi familia está tan preocupada? ¿Qué puedo hacer?

La Red Nacional de Prevención del Suicidio (1-888-628-9454) es una excelente fuente de apoyo. Es para personas en crisis, no sólo si estás pensando en terminar tu vida. Cuando llamas a la Red, tu llamada será dirigida al centro de crisis más cercano a ti. La llamada es gratuita y confidencial. Un profesional de la salud mental estará disponible para escucharte y ofrecerte información acerca de servicios de salud mental en tu comunidad.

Recuerda, no hay vergüenza en pedir ayuda. Todos necesitamos un pequeño empujón de vez en cuando.

Se Inteligente. Se Precavido. Se Saludable. Se Fuerte.

¡Hasta la proxima!

Dr. Félix

Welcome to My Blog!

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Hello Dear Reader:

Welcome to my blog!

I plan to address mental health issues: from stigma to advocacy, from medications to therapy, from conventional to alternative, from funny to serious, from hot topics to current events.

I hope you will find the content of my blog useful and educational.

Off to write I go!

Dr. Felix